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PERMITTEE NAME/ADDRESS Ilnclude Facility Name, it 1)iffir,w) <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 />Form Approved. <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br /> <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br />PARAMETER EX ANALYSIS TYPE <br /> AVERAGE I MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br /> SAMPLE <br />MEASUREMENT <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT r <br /> SAMPLE <br />MEASUREMENT <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ._. , <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />. <br />' <br /> REQUIREMENT , <br />; <br />D -I T 1 • . <br /> SAMPLE , .'1 /.A r- <br /> MEASUREMENT <br /> <br /> PERMIT s? . . <br /> REQUIREMENT <br /> SAMPLE . <br /> MEASUREMENT <br /> _r <br /> <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I eertih tinder lwnait> d i..a that this d.-intent and all attachment, were TELEPHONE <br />m d <br />si <br />ned <br />with a s <br />st <br />d DATE <br />g <br />- - <br />y <br />e <br />e <br />ance <br />prrpan•d under my direem-n a iatpen ision in uesor <br />- i to assure than qualified pcnnnnel properh gather and esaluair the inrommitnai <br />ersons whir manage the system. <br />r th <br />-m or <br />i <br />d <br />. <br />' . - ?? <br />p <br />ry o <br />mp <br />- - - submitted. Hmed on me <br />e ta <br />- <br />. <br />or th.rr rsans dlncth n -ptmaible for gathering the information, the inrartnation <br />tL ?' ? <br />?? , <br /> <br />L <br />to the best .J wy ktn.wiedgar and belief. Inw. "curate. and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br />• ` <br />? submitted h <br />; e' <br />?' ?' <br />s <br />?C , <br />bmitting fulsr mrormution <br />lti <br />fo AREA <br />v <br />L+? <br />F <br />: . <br />r su <br />es <br />I am aware that then an .lwniBeanl pena OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED including the W»sibiliq of foe and imprisonment for km.w ing siolati.ms. D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Frererence au arracnrnents !/CtCJ <br />I EPA Form 3320-1 (Rev. 3/99) Previous editions may be used <br />I nis is a 4-pai I w i <br />OF