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PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />Na <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 />I tertdt under pertain of lams that this docmuent and all attachments stet <br />pi eparcd midi' rot direction it supmtision in accm dance ttth. ,{stem designed <br />to asset C that qualified pei sonnet moped t gather and etaluate the udornmlton <br />submitted lined on nn unpin t of the person or nelsons who nit nage the system, <br />or those pm sons directly responsible lot gathering the ntm matii n, the information <br />submitted is, to the best it rot knowledge and belie. true, accurate. and complete. <br />I am attain that there are signd Kant penalties lit submitting sal e intm matron, <br />including the possihihh it line and unprninment for knotting tmlatiins. <br />TELEPHONE <br />DATE <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED <br />AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />PERMITTEE NAME /ADDRESS (Im6tde futility Vame /Iwalma if Different) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />MMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320 - 1 (Rev 3/99) Previous editions may be used <br />FROM <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 />This is a 4 -part form. <br />Form Approved <br />OMB No 2040 - 0004 <br />NOTE: Read Instructions before completing this form. <br />PAGE OF <br />