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PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />EX <br />FREQUENCY <br />OF <br />ANALYSIS <br />SAMPLE <br />TYPE <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />1 telttt minder I"'nitl) n1 tat. that alt. docmnent and all altachm'ms " <br />w epar! d nnlll1 nit du ectum or sup •■msion in accordance t.th . ssstenm designed <br />In .1,111 a that qualified personnel pt mperIl gather and a aIuatc 110 utlon illation <br />suuoutted. Rased 011111 \ 11111111! \ 01 I le person or persons ttluo nr. nage the stdenm. <br />o1 those persons du CCU) responsibh for gathering the informant n. the mlormation <br />submitted is to the hest of nit k110 \I edge and belief. rue, aumrate, and complete <br />I am !mare that there are significant for submitting fat e Information. <br />TELEPHONE <br />DATE <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />penalties <br />TYPED OR PRINTED 1 !minding the possibddt ■1 line and imprisonment lm knotunt t adattons. <br />PERMITTEE NAME/ADDRESS Ilmhlde I at \ante /L01Ot t o Il ntlle;ent) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />FROM <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320 -1 (Rev 3/99) Previous editions may be used <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER <br />YEAR <br />MO <br />MONITORING PERIOD <br />DAY <br />TO <br />YEAR <br />DISCHARGE NUMBER <br />MO <br />DAY <br />NOTE: Read Instructions before completing this form. <br />This is a 4 -part form. <br />Form Approved <br />OMB No 2040 -0004 <br />PAGE OF <br />