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<br />PERMITTEE NAME/ADDRESS rlnehtde Farilirr A'um.;lnrari,n i/ Piffrrrnu <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />4"^d(-- rPlFF=) <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 2040-0f:f)1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION ND• FREOUENCY <br />OF SAMPLE <br /> <br />EX <br />ALYSIS TYPE <br /> AN <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE t r! v I_e,? AL <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> s <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I erriih under penn11 ..4 I"" that th" docanrrnt and all attachmtnts mere <br />prepared under m) dim non or %olm-i.ion in actordanet with it system designed <br /> <br />? TELEPHONE DATE <br />'` ` . J ., .. ' J • ?? , '- . C r i <br />` It, assure that qualified I% onnel pnoperi? gather and evaluate ilk information e_ _ -- -?' <br />'? <br />•i `-- <br />- whmltird. 8med on in inquiry or the prr.on or parums mho manage the system. <br />s dtrectls -,i xa siMr for gathering the inrorenation. the information <br />r.u <br />th <br /> or <br />- pt <br />n <br />i <br />V C r. <br />uhmitled i, to the best of my kmwledge and belief. true, arPuratt, and comple <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> bog false information. <br />I um amarc thin there arr.fgni penalties for OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />I YEAR MO DAY <br />TYPED OR PRINTED for hn <br />including the lwn.ibilih or rme and and i ngtrivtatment for knowing violntitats. <br />DE <br />COMMENTS AND EXPLANATION OF AN <br />(xererence au arracnrnt:ms itut Ci <br />FOR P EQU. `? EMENTS <br />EPA Form 3320.1 (Rev 3/99) Previous editions may be used. -• ni,, I? d 4-part form.