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PERMITTEE NAMElADDRESS rbt6nde F.-jurr ti'ume ll+rarinn /lir!(ennu <br />NAME <br />ADDHESS <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 />Form Approved. <br />OMB No. 2040-0004 <br />R13LA v <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />? QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREDUENCY <br />OF SAMPLE <br /> I EX TYPE <br /> >< ANALYSIS <br /> j AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />iYE OE t <br />(;?i? <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />:JR <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t <br /> REQUIREMENT r • k'.'G <br /> SAMPLE <br />?• MEASUREMENT <br /> PERMIT '•' a t sY:-f?r3R t _ "RAE-I <br />r t , ; . _a REQUIREMENT r , <br /> SAMPLE <br />=. f: A'. t.. _ MEASUREMENT <br /> PERMIT _ R EP OR` <br />i-r REQUIREMENT L?A H'. C- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r <br /> <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ccnd} under penalty of lain that tht% document and all attachnmcnt% wrre TELEPHONE DATE <br /> prepared under m} direction or sulxryisnn in accordance with a sys!cm ?! •sigxd _ <br />- <br />- <br />?-- to &wire that quallf ied personnel property gather and e, alualc the information ' - - - - <br />- - . <br />/? submitted. Based on my inquiry of the person or persons echo manage the wstem. _ <br /> or those person. direx:ify re:ptmsuhle for gathenng the information, the mimmahan <br /> whmitted i, to the hest of my knowledge and behct, true, dccurdtc, and complete. <br />i <br />i <br />l <br />i <br />fo <br />b <br />tti <br />fal <br />i <br />f <br />i <br />1 <br />h <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED am aware that t <br />ere are s <br />cant pena <br />t <br />es <br />r su <br />mi <br />ng <br />se <br />n <br />ormat <br />on. <br />gn <br />f <br />t fo <br />k <br />1 <br />t <br />th <br />hm <br />f fi <br />d <br />n <br />d OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> ty o <br />ne an <br />unpn:xnmen <br />noll mg %w <br />mg <br />e pow <br />r <br />a <br />ons <br />mc <br />u CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all aKachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. I; - This is a 4-pan fonn.