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PERMITTEE NAME,'ADDRESS hulude Factlrn N,vnc.L,aartnn iifnirenn <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 />i i <br />Form Apprpyed, , <br />OMB No. 2040 0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - • * # f si =F'' ',. <br /> REQUIREMENT - -1 <br /> SAMPLE l <br /> MEASUREMENT <br /> PERMIT r 7ti Af, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i W k;, yRAE- <br /> REQUIREMENT ? Fi <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f a A :> o-i4# .s i ?F#j! ?i t r 00 ii <br /> REQUIREMENT 30DA A`!;_ <br /> SAMPLE # a :. x <br /> MEASUREMENT <br /> PERMIT -:f lO .DF-4T 3F Ai, <br /> REQUIREMENT <br /> SAMPLE / -. <br /> MEASUREMENT <br /> PERMIT i+ r RF-P f:R T t:rir ### A 71'• i!'•I i. ., i <br /> REQUIREMENT ;'liVG' <br /> SAMPLE r# t u <br /> MEASUREMENT <br /> PERMIT wit #: #w t ?fa?r,s );Ff Pi r?FF"? t.?? <br /> REQUIREMENT <br />NAME'fITLE PRINCIPAL EXECUTIVE OFFICER I .emf% under penah% of law that this dmument and all attachments were <br />' <br />d TELEPHONE DATE <br /> iston to accordAnce u ith n scstem designe <br />prepared under nn direction or supen I <br /> In assure that qualified IMrsonnel properly gather and cvalunc the information <br />I <br /> submitted. Based on my ingmr} .rt the person or persons who manage the system. <br /> or those persons dircnh' rcaptnsible for gathering the infomwtion, the mfomtation <br /> suhnuncd is. tu the best of rny. knowledge and bchcf. true, auunce, and s:omplcle <br />t <br />lti <br />f <br />r <br />hnurrmn <br />t <br />ke infomiam- <br />I <br />d <br />h <br />i <br />h SIGNA RE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED ere are signif <br />can <br />pena <br />o <br />su <br />g <br />a <br />n. <br />am aware t <br />r <br />t <br />es <br />nd im <br />n.onrrent tin kno-ne atolanons <br />l <br />th <br />l <br />of f <br />ne <br />di <br />b <br />t <br />OFF ER OR AUTHORIZED AGENT <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br /> inc <br />u <br />i <br />a <br />p <br />ng <br />e possi <br />i <br />y <br />i <br />COMMENTS AND EXPLANATION OF ANY VIULATION5 (Reference all arfacnments nere) <br />PREC IP EVENT SUE-:jE , T TO BURDEN! OF PROOF REGUIREMEWs j N <br />E:? rO THE "•TVISION' WITHIN 4;- HCUPIZ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used '4c Tht3'is a-4pmrt fenn.