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NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (D MR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO, DAY YEAR M0, - DAY: <br />FROM ' . - .. TO ` <br />Form Approved. <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 /> <br />SAMPLE .7? <br />y. - <br />r . <br />- <br />==• MEASUREMENT <br />t : PERMIT <br />" Y .'.,. ,. ,. • _; ?.- ",.f REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f <br /> REQUIREMENT s <br /> SAMPLE f . <br /> <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ` <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel properly gather and evaluate the information <br />submitted. Rased on my inquiry of the person or persons who manage the system, <br /> <br />..--•? ? <br /> or those persons directly responsible for gathering the information, the information <br /> <br />submitted is, to the best or my knowledge and belief, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE y <br />?QN-'?' ?U <br />10 Q <br /> <br />Y <br /> <br />TYPED OR PRINTED 1 am aware that there are significant penalties for submitting false information, <br />including the possibility of tine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reterence all attachments nere) , _ ('_..?:, :, ?-?• ;Ga ?.?., ?r,:.' -? r-r.?.-? r. ., ? ? s"y ? ? i ??+ I"? t r :: 11:i BURDEN ? = ? OF <br /> ?k '" t"'Ri:IC'? °'? B • <br />.r <br />w,c <br />tf- S? ° , ?(Jji.,s.9,_ .?`, 'ill' U ' - -'",r, r.,_xa, e ? l i`!r» /?1+??? '[1i1j (i,? (;?! )l7 ?: f 4._??I???t. <br />< <br />? ?? C'1 -/iPa 4-Wr QnU- PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.