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PERMITTEE NAMEiADDRESS u,:,du,.. I a, da % <br />nc- <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 /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />F MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br /> PERMIT t r <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 cetttty under penalty of taw that this document and all attachments acre <br />i <br />i <br />d <br />h <br />d <br />d TELEPHONE DATE <br /> ance w <br />a system <br />prepared under my direction or super <br />slon in accor <br />t <br />esigne <br />-- to assure that qualified personnel proper[ gather and c%alwne the mtorrttanon _ <br /> submitted Based on my inquiry of the perum or pe"ons who manage the system, - - ' <br /> or those perstms directly responsible for gathering the information, the information <br /> <br />/ submitted is. to the bcst of my kn ledge and belief. we, accurate, and complete <br />ti <br />nt <br />n it: <br />, for ,ubmium <br />false mtm, tioa <br />th <br />t a <br />, <br />I SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED _ <br />pe <br />rc <br />t ni <br />r <br />g <br />am aware <br />a <br />including the p-, nihr, „t tin .r. ,: unpm:•m ,rot Glr knowing %wlation, OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />GVMMtIV I D APlU CAP LANAI IVIV Ur ANT VIVLAI IUNQ (nrlarCnce an <br />1willrClll* IIC/C? <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. !?Cj r, ,This is a $ part form.