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--NMITTEE NAMEADDRESS <br />,;,1 E <br />-,DDRESS <br />I auTY <br />1{ CATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No. 20404 <br />Nr)TF• --- <br />PARAMETER QUAN TITY OR LOADING QUALITY OR CONC ENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />SAMPLE <br />MEASUREMENT <br />PERMIT - <br /> . <br />t r_ <br />r` '.. <br />c r - REQUIREMENT , .. ._. ' <br />SAMPLE <br />MEASUREMENT <br /> PERMIT <br />`r <br />! REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />•.1r-: •; REQUIREMENT <br /> <br /> SAMPLE <br />r ;c i_ F: '• MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> ;t, <br /> SAMPLE <br /> MEASUREMENT <br />' PERMIT <br />- - #?x s • , T F• 1 <br />- D5S? REQUIREMENT <br /> <br /> SAMPLE <br />'" (s_ ', •; MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> <br /> SAMPLE <br />' .. MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 ccrtify under penalty orlau that this d,wument and all attrchmettrs wer` <br /> <br />prepare] under mr dircc4on or .upon-imon to aca,rda,u:e wnh a ystem de,tgned <br />l TELEPHONE DATE <br /> <br />- to assure that qua <br />ified perwnncl properh gather and evaluate the mti,mtatmn <br />b <br />i <br />d _ %?- <br /> tte <br />+u <br />m <br />Based on m) myurr of the per: in or perons who manage the system. i -- _ <br /> or thou perwns directly reslxrastble lbr gathering the mfi>mtatiun. the ints,mtan„r, <br />i <br />h <br />d ' "?- <br /> u <br />m <br />tt <br />s t the hest of m) Lr, tt I d Ie u d belief. tnto uc.urate• and compute SIGNATURE OF PRINC <br /> <br /> <br />TYPED OR PRINTED <br />f r, .n a ,liar thu , .ipnrl mi .i u : r ihn nvn_ ral,e inforinattor, <br />1 <br />ih IPAL EXECUTIVE <br /> <br />OFFIC _ <br /> : s <br />iht ,, i ", ng Lwhowns ER OR AUTHORIZED AGENT AREA NUMBER <br />coD YEAR MO <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL <br />ATIONS (Reference all attachments here) <br />E DAY <br /> <br />EPA Form 3320-1 (Rev. 3.99) Previous editions may be used. This is ,a 4-part fon11.