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44 <br />PERMITTEE NAM E/AD DRESS, In<ladr l,rrdu, %,,m.rhnatr,n it mito,nt <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION r: R! )`i i; <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION ND• FREQUENCY SAMPLE <br /> <br />EX OF <br />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 <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 ,en . nnder In Ai, of Law that ihi. d„ ument And :d1 aluchim-W, were <br />•d <br />d <br />di <br />n <br />with <br />t <br />m d <br />.i <br />•d <br />i <br />i <br />i <br />h TELEPHONE DATE <br /> a .?. <br />rr - <br />ne L <br />nn .a wywrc <br />m <br />n aaann <br />mce <br />r <br />r <br />Lrw <br />Pnpan <br />un <br />. <br /> 1,. w.mre II t q'uhr-l Iw•nnnnel Pngw rh LAther and r\eluule Ihr i l,\,,, tinn <br /> .uhf w.l. Ii-d u nu in iuir, of the Iw•r,.m , r i-- whu m:mage the •, Hrm. _ - <br />- <br />- <br /> r It,- I-o., dwn,it, rc,i-n l,I, lur Lathering the infurnut ion, the mh,rarAWm - <br />- <br />- _'" <br />• <br /> u -iil,A i.. In thr Iw.t .d - klLi\, IrdLr And I.1,0. 1ru,. :IaCnl'AIc. anll ainntdetr. SIGNATURE OF PRINCIPAL EXECUTIVE -J I -' `" ? <br /> 1 um e.-,, Ihut there Are 0gnifi-111 Iwnalti- for -hmwtin_• fAly in4,rmaunn. <br />ER <br />R AUTH <br />FI <br />RI <br />D AGENT <br />AREA <br />TYPED OR PRINTED m.Iuding the P nahdih ..f hna .m I in Pp,r ,,n-.i air hnu..ing i dun\nn_ OF <br />C <br />O <br />O <br />ZE ODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />rzN EVENT ".)Ci'.. E I TO BURDEN OF PROOF r?Euk-i1PF-:'-'E-NTE <br />TO Thi := D 1V 13 1 7AN W f TLi' T N 48 i-i&JR'-- <br />Thi. i, a 4-part lmn. PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used