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PERMITTEE NAME/ADDRESS tinrludr Facilirl Nunn. 'L„ ali.m .l myo-rnu <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />k-1 NT=ER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 /> <br />NOTE: Read Instructions before completing this form. <br />C'• t-; TT <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE C <br /> MEASUREMENT <br /> <br /> PERMIT -4 A <br /> REQUIREMENT %'- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT A <br /> <br /> PERMIT - - , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r r:: <br /> REQUIREMENT ?1_.7 rl•dNUF <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 737 <br />• r <br /> REQUIREMENT <br /> SAMPLE ? <br /> MEASUREMENT <br /> PERMIT _ ,.. <br /> REQUIREMENT - ` : _ Y r: <br />- <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cerlif? under la•nalh OF I- that tile. 11.a-umeni and all attachment. were <br />e <br />r <br />i <br />i <br />d <br />d <br />di <br />i <br />i <br />d TELEPHONE DATE <br /> <br />- <br /> <br />?C', - •r',-, p <br />el <br />tre <br />un <br />er - <br />nn nr -P- <br />c <br />on <br />relt <br />n ac.nr <br />umr with a ydem desigmd <br />to a-ure that qualified nm•I gather and et Wattle the information <br />t+t•rso t..da• <br />submiucd. Raid un mi mymrt or the Ix•rvm or penons whn manage the stem. <br />r <br /> sir thost pen,m. direct) n-spmstNe G.r gathering for inGrrma7ion, tltr (nfarmalion `i _ - - , <br />\ L- cutmtiti d m to the be.l .f m? knpwdedfv and bedicf. 1-...... te, and -replete. L <br />- 1 am aware that there are significant penaltit, fur %ohmnhng falsr inrormati,m SIGNATURE OF PRINCIPAL EXECUTIVE ` " <br />TYPED OR PRINTED . <br />including the it-sibtliq of fine and impriwmment for knowing ci-dntiom. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used. This is a 4-part form. PAGE OF