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PERMITTEE NAMEIADDRESS (include Foeifih Aamdloratian iffnp'erent) <br />NAME l- <br />ADDRESS <br />FACILITY <br />LOCATION c, C I,t (' 1 :? <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />ROIJTT <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />-.' <br />T <br />. <br />4- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElrITLE PRINCIPAL EXECUTIVE OFFICER I rer if. under Renal, of law that this dot umenl and all ultochmenl, were <br />i <br />h <br />i <br />d <br />d <br />di <br />i <br />• <br />W <br />i <br />d <br />d <br />d <br />` <br />-- TELEPHONE DATE <br /> <br /> <br />- rect <br />on or wlx. <br />on <br />ance w <br />a +ysivni <br />gnr <br />prepare <br />un <br />rr nn <br />n <br />n acoor <br />t <br />e+ <br />to a-re that yu diiried per onnel prnfx•rf? gathrr and e,duar the information <br />suhmittM. Batted on m) inyuirn or lhr Ix r on ur peon- who munagr the . s'I m. ? <br />_ _ - <br /> or thox (tenon, direclh rr,ponniblt for ;athering the information. the information -! <br />- <br />- whtnitIM I,. to Ihr I-1 of m% knowledge and Ix-lief. Into. accurate, and complete- <br />b <br />k <br />f <br />h <br />ir <br />l <br />f <br />i <br />f <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />- <br /> err urr sryln <br />or su <br />or--ion. <br />I am aware that I <br />icani prna <br />ur+ <br />m <br />tting <br />a <br />e <br />n OFFICER OR A <br />IZED AGENT <br />TH AREA i?] <br />TYPED OR PRINTED includint g the Ix-ibiW, of fine and impn o--1 fur knowing i I ttiom. U <br />OR <br />- NUMBER <br />CODE YEAR MO COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> <br />EPA Form 3320-1 (Rev. 3(99) Previous editions may be used 0 00-9 This'is A 4-part form.