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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 />I dertd■ under pen.dt+ ot la+, that this document and all attachments acre <br />in epara d under mt direction or sup •rveaon in accordance a rib ; ci stern designed <br />to ascot that qualified personnel pr open is gather and e+atuate the nilor matron <br />submitted. Based on me uulutr+ of the person or persons aho manage the Si stem, <br />or those pet sons (bree tic responsible for gathering the mtormation, the rntormatton <br />submitted is, to the best ot nn Eno+ +ledge and relict. true, act ri ate, and complete. <br />I .i, a , .,e r tb a thei are .rgndkan( pen dies for suhnultmg false mho matron. <br />■dludm the posstbrht+ of fine and rmpr rsonnu•nt for huoanro +udatrons. <br />TELEPHONE <br />DATE <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />AREA CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED <br />PERMITTEE NAME/ADDRESS IInelude Fardtn \ame /L,vatinn it Di//ctrnt) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320 - 1 (Rev 3/99) Previous edition o may be usced <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 />DISCHARGE NUMBER <br />YEAR <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 />