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PERMITTEE NAMEiADDRESS (huhide Fa ilin•,Viwne-L«wlionrfDrffewnt) <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 /> MEASUREMENT <br /> PERMIT I J I (_.7 <br /> REQUIREMENT ; 1' I i I' i. • . t t <br /> SAMPLE <br />r MEASUREMENT <br /> PERMIT 7,? <br /> REQUIREMENT ; ,• i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />- L i li_i ' REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r a I - <br />c r. REQUIREMENT n '. F- '•IT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />TL! <br /> SAMPLE ` <br /> MEASUREMENT <br /> PERMIT .. •r -, _ - _ Fir . . . <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certiR under (malt} of law that this docurnent and all aua.hrucnt. were TELEPHONE DATE <br /> prepared under my direction or supen ision in accordance with a system (I signed <br /> to assure that qualified personnel properly gather and evaluate the information <br />d <br />d <br />B <br />i <br />f <br />h <br /> suhmme <br />. <br />ase <br />on my inqu <br />ry o <br />t <br />e person or persons whit manage the symcm. <br /> or those persons dirrctly responsible for gathering the inlinrnatiou, the intbmtatinn <br />_ submitted is. to the best of my knou ledge and belief, true, aaurdw, and complete. <br />m <br />t th <br />r <br />t <br />lti <br />s <br />I <br />h <br />if <br />f <br />b <br />itti <br />f <br />l <br />f <br />i <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED auuc t <br />ere a <br />e stgn <br />iran <br />es <br />a <br />a <br />pena <br />or <br />u <br />m <br />ng <br />a <br />se <br />n <br />ormat <br />on. <br />including dx pnssibihr: of fine and tmprt.comnrnt for knowing violations. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />ANU LAYLANAIIUN Ur ANY VIULAI IUN, <br />all ana CnmenrS nere) <br />EPA Form 3320-1 (Rev. 3!99) Previous editions may be used. }?I This is a 4-part form.