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PERMITTEE NAME/ADDRESS tluclude FaeiGtp Nam„7nrv«:, if 1 ,11, rent, <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />Ili IP-!EF <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. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> _ i S L l I, I c t <br /> MEASUREMENT <br /> PERMIT - r; <br /> REQUIREMENT <br /> SAMPLE <br />' f =1.,? <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 />- <br />r' <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />1 <br />?? <br />I"ISy <br /> MEASUREMENT - <br /> PERMIT _ Y I :? ; <br /> REQUIREMENT <br /> SAMPLE r t / <br />' <br /> ,J- <br />` IS`-' <br /> MEASUREMENT <br /> <br />ERMIT <br />P - <br />- <br /> i <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under la•nalh ,.f L.» that Ihis d,wuntanl and all attachments were <br /> <br />d <br />i <br />d <br /> <br />` <br />TELEPHONE <br />DATE <br />_ Prapan+l under m? dire elion ar .upeni.ion in acrurdancr with a % %tem <br />e. <br />mne I <br />_ ? --r -xi: s _ to asurc that yualifted pcrsonnrl prnprrlr gather and esaluate the infnrntntian I ? <br />?? <br /> submiutd. Based nn m? inyuin of the perwn or pees- who manage the system. - <br />- nr th„se prnon% dirndl) responsible fur gathering the information, the information <br /> l <br />t <br />d b <br />l <br />f <br />d <br />l L 1 <br />J <br /> e, an <br />comp <br />e. <br />submitted is. to the M•s1 of my knowledge, an <br />e <br />ie <br />, true, ame- <br />e SIGNATURE OF PRINCIPAL EXECUTIVE - - - - <br />. <br />TYPED OR PRINTED I am aware that there are significant 1-a]Iirs fur suhmitting false information. <br />inciudiug the Possihilily or nine and imprisonment for knowing siolali,ms. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE 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.