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?1 <br />PER,MITfEENAME/ADDRESS,lnrtud. FmiGn \,u,rdennri.ut,/UI/)irrIII <br />ftME <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 />F ,!m Approved <br />nf,aB No. 2040 u00: <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT I <br /> PERMIT <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,rrtiqunJrrP•nnlt nfluethwthi.d«umrntand allatlachmrnnerrr <br />- <br />i <br />d TELEPHONE DATE <br /> Prepared under m, 'I-'Ii on of .It1. in : k-t <br />tlanrr a ith a .,.ten, dI- <br />gnr <br /> <br />• . ." ' _ n. a- m lhat ii-IiNA wr.onnrl pn.perl, gmhrr and r, uh,rtr thr inforrnmwn <br />th <br />, <br />t <br />m <br />t <br />d <br />A <br />h <br />h <br />? . e P-n..r Ixt..m. a <br />o manage <br />e. <br />. <br />, <br />,ubmitlrJ. I <br />..n m, iuqutn <br />t <br />e <br />.- <br />- - <br /> or III.-- Itt n. di-tl, rr?lwn.iblr f,.r GtlhrriuID the inhmmalinn, the information -' <br /> mbmit[ed i.. In Ihr 1-1 or m, Lno„ Iedgr and IKIt,•f, true, aerunde. and ...mplrte. SIGNATURE OF PRINCIPAL EXECUTIVE '- <br /> <br />TYPED OR PRINTED 1 am awun Ihm Iherr ur.i?ndic:mt P-Iltir, h.r .ubmiuing w- itd..nuaiv,,,, <br />in, Indiny Ihr iv-ihitiic ..f finr and impriro...-, fo. Mn.oine ,ioluti. u' OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANA I IUN Ur ANY VIULA I IUNb (rrererence au arracnmenrs nerej <br />O I P EVENT SUri JE <br />TJ'• T`•iE DIVTr31IFIN <br />BURDEN OF PROW: REa <br />ICJ ?`? Hryt..'R_; <br />?u: fhit is ;i'4- itrt ibrln. <br />EPA Form 3320-1 IRev. 3+'991 Previous editions may be used.