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PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NQ. <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 "'lilt amlerr pen.dh al lam that this dot mnent and all attachments tte1e <br />prep. cd under nth du ec lion or sup •rvsion in accordance etch a sestem designed <br />to asset e that quahlied personnel in teeth galhet and etaluate the information <br />subnutled. Based on MN uupur■ of I to person or persons abo manage the s\stent, <br />in those pct sans du eclh I esponsiblt for gathering the ud'm oration, the information <br />submitted is. Iii the best of nit knowledge and belief, It ue, accurate, and complete. <br />I am art at e that there are stgmhuut penalties tar submitting false information. <br />including the possibdth al line and imp imminent lm knoeutg cudattons. <br />TELEPHONE <br />DATE <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED <br />AREA <br />CODE <br />I NUMBER <br />YEAR <br />MO <br />DAY <br />PERMITTEE NAME/ADDRESS (Include Facility \amelLoca(ion 1/ Ut( /emrv■ <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />EPA Form 3320 -1 (Rev 3/99) Previous editions may be used <br />FROM <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM N PDES) <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 />