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PERMITTEE NAME/ADDRESS dmtudr 1,mlat ?unrra..<<rt, a it l+if(+>'+di NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />OUT 1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />S <br />R <br /> MEA <br />U <br />EMENT <br /> PERMIT r i11Z. t- :. -. _ y r <br /> REQUIREMENT A`.: <br /> SAMPLE <br />A <br />R <br /> ME <br />SU <br />EMENT <br /> PERMIT _ s - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT } ;' •. <br /> REQUIREMENT <br /> SAMPLE <br />A <br />REM <br />N <br />T <br />' ' <br />? <br />A? <br /> ME <br />SU <br />E <br />T • <br /> PERMIT .. ai r <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penal" of law that mi. d-unenl and all atmcbment+ wen, <br />prepared under m <br />direction or .u <br />enidon in accordance with a system do-lined TELEPHONE DATE <br /> <br />- <br /> <br />c y <br />p <br />In :LI\Url' that r111+IIIOIVI pertoanl•I pfnpl'rI1 gather and l'%ahmle the ipfuritrallnn <br />-hrnitted. Raced mi in) mllui" of the penon or pervin\ whu manage the,e11em• _-+-+ <br /> ,r thrice pen n. dir -IH recpomrble for Gathering the information, the information <br />' <br /> .uhmitt I n, the 1-1 <br />4 me knowledge and lwdiel. true, accur.ve, and complete. - , Z ' >` • j l <br />" J ; -? <br />v ` L I am aw:ur thm their ne igniri-n <br />enaltie. I-.ubmitting talcs udormaG, n SIGNATURE OF PRINCIPAL EXECUTIVE - - <br /> <br />TYPED OR PRINTED p <br />. <br />adudm, Ure <br />w^Lmt? nI rinc and tmproonment I- J, using,'I1 +rc,. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3(99) Previous echtions may be used. OO TI11S IS a 4-{lart'fonn.