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PERMITTEE NAME/ADDRESS (lneludc Faeiliq'.Name/Loration if Different) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <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 />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE %4, <br />(hI?IT?1 <br /> MEASUREMENT <br /> PERMIT = . _ <br /> REQUIREMENT r•, ; , <: ; `,:_:, <br /> SAMPLE <br />'•_> <br />PIN <br /> MEASUREMENT <br /> PERMIT ` <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r • :-.. <br /> REQUIREMENT i? <br /> <br /> SAMPLE .? ?..? <br /> MEASUREMENT <br /> t . <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />' <br /> MEASUREMENT <br /> PERMIT .. <br /> REQUIREMENT r t }i-':;yT}rt <br /> SAMPLE -rc rj I A <br /> MEASUREMENT <br /> PERMIT , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT - - ' <br /> PERMIT <br /> REQUIREMENT <br />NAMElrITLE PRINCIPAL EXECUTIVE OFFICER rwiwlf? 1-to <br />that hkdi n-1AndallLtiLrhment?wefe <br />e liA unde <br />I <br />TELEPHONE <br />DATE <br /> ` <br />r <br />p r. I ,n to an nrdanrt with A -tern d-igned <br />Unn I <br />l <br /> lit a'-re that yuahfird Ix•r-nnel properI% gather and eraluate the inf'-Atiun _ <br /> •ttbmittcd. Raid on mr mgain of the prison m pcnrmc w ho mumtgr• the .}.tem. _- <br />y <br /> or those pi-n% direv11% i -liti..iblr• Glr "thenng the udnrmatinn. the mfurmAtion <br />•' <br />•,l <br /> d c <br />lete <br />I <br />•I <br />L ??'? - '--' l- - t. ' ? <br />- -mot- Vw, rx¢vrate. An <br />llmi) <br />. <br />x <br />ic <br />tibmitwd ir. w the hca of m) kmlwirdgr and SIGNATURE OF PRINCIPAL EXECUTIV E <br />• - I Am Aware that there arc oLnirwant pcnaltie. I- %uhmitting faAe information. ENT AREA <br /> ri-nment for knowing violation.. <br />xnrihilih of fine and int <br />th <br />i <br />l <br />di OFFICER OR AUTHORIZED AG NUMBER <br />DE YEAR MO DAY <br />TYPED OR PRINTED p <br />ng <br />e I <br />nc <br />u <br />COMMENTS AND EXPLANATION OF ANY <br />(Rererence an arfacnmenrs here) <br />EGUIREMFENTS <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ' TIti1"iS' A 4-0A ,form.