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PERMITTEE NAME)ADDRESS pwrbr F. 01, N... L«.Ilow (/D{Ofwwrr) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPOES) <br />DISCHARGE MONITORING REPORT IDMR) <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 />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT ` <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> <br /> LE <br /> MENT <br /> IT <br />F <br /> MENT <br /> <br /> LE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT yl <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER 1 rtn'ly under penalty o I.. th-1 this dorvment and It amachmertts were <br /> p"pared under my dlr rtton or mperelslow In accordance with • system dedVwd TELEPHONE DATE <br /> to inure that quaMned personnel Ilrope ly [ether and [value/e the I <br />forr <br />l <br /> n <br />nal <br />on <br />eubmltted Dosed oct my Inquiry of the person a prrsorn who manage the system. <br /> a 'how prrs.re directly, rteporrdblr for gathering the Information, the Information <br /> submflted is, to the best of me kn.wfedge and beDtf <br />lr <br />a <br />t <br /> , <br />„r, <br />ra <br />r. and m rrplatt. <br />I am a.an that then <br />girt <br />t <br />Nft <br />t <br /> <br />TYPED OR PRINTED : <br />s <br />g <br />can <br />penalties for sub-Ildng false lnform dim. <br />Including the <br />ndblllt <br />of fl <br />d I <br />t SIGNATURE OF FRINCWAL EXECUTIVE <br /> p <br />y <br />oe an <br />mpr <br />gionmrnt for knowing vlolsUom OFFICER OR AUTHORIZE A A <br /> <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL <br /> <br />ATIONS (Reference all attachments hare) D AGENT <br />NUMBER <br />CODE <br />YEAR <br />MO DAY <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used <br />This is a 4-part form. PAGE OF