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PERMITTEE NAME/ADDRESS(I.,"F-di?y/V.-.'L wi-t/DI&-t .rATIONAL POLLUTANT DISCHAAOE ELIMINATION SYSTEM (rNPDESI ..rpmcw? <br />NAME DISCHARGE MONITORING REPORT (DMRI c:; ,c ?Gap-ado: <br />ADDRESS <br />i PERMIT NUMBER ascHAnoE wuMeot <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />fRUM TO <br />NOTE: Reed Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />EX OF <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS 'YPE <br />L?L L ?? Iv - <br /> <br />EXECUTIVE <br />REQUIREMENT <br />SAMPLE <br />AEASUREMENT (?-? <br />- - -- -- <br />-PERMIT <br />REQUIREMENT <br />wbmllird. <br />nr Iho a <br />PA Form 3320-1 (Rev. 3/99) Previous editions may be used <br />I <br /> <br />I <br />TELEPHONE <br />rm OalEnM , , <br />'nrnullon 4 - --?-'. <br />r the mtem. <br />InrnnrulI.n <br />J <br />b cem?Iere. ; <br />tt1n.I/on, SIGNATURE OF PRINCIPAL EXECUTIVE ?. <br />OFFICER OR AUTHORIZED AGENT t•nKill: n? NUMBER YEAR M'l I pAv j <br />This is a 4-pan fonn. PAGE or: