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PERMITTEE NAMEiADDRESS,f... h„ h i,,.,wr. u <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <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. 2NO-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <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 ccntfc under penalty of law that this docurncni,,nd allartachments were TELEPHONE DATE <br /> prepared under my drrect+on ur supervision to accordance with a system demgned <br /> <br />.f, to assure that qualified personnel proporty gather and evaluate the information <br />submitted. Based on my tnywry of the person or prrons who manage the -stem. <br />r- .r-- #rrf": . - <br />? <br />, the information <br />erons directly responsible for gathering the information <br />or those -•' f? <br />" "' -? <br /> . <br />p <br />submitted is, t„ the best of my kno,v ledge end belief. true, accurate, and cornp !etc <br />d <br />f <br />b <br />i <br />f <br />tb <br />i <br />l SIGNATURE OF PRINCIPAL EXECUTIVE <br />' <br /> cam rcn. <br />tie, <br />or su <br />mu <br />ng <br />a <br />se m <br />I am aware that there arc signit <br />mran,,n, <br />h <br />k <br />t <br />n <br />f <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br />TYPED OR PRINTED a <br />t <br />ne ana v=,, r > anncm t <br />r <br />nowing cu, <br />oRS <br />mcluaing the possibthty o CODE <br />COMMENTS AND EXPLANAIIUN OF ANY VIUL.AIIUNS (Hererence an arracnmenrs nere) <br />EPA Form 3320-1 (Rev. 3/99) Previous edidors may be used. This is a 4-part form.