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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 celilly under penalty of lao that this doc anent and all attachments 'Acre <br />prepay d under nn du citron or super%ision in accm dance mu) . system designed <br />to assur c That qualified personnel pr 'perk gather amt es aluate Ire information <br />submitted Based on n» inquiry of the person or persons who m: nage the ss stem. <br />to those persons chrecllr responsrhle for gathering the color mat], n, the mformahon <br />submitted is, to the best of unit hnmr ledge and belief, ti ue, accurate, and complete. <br />I am :mare that tiroe are signit leant penalties for submitting false mfurntatton. <br />including the possibility of line and imprisonment im kilo, in Milton, ns <br />TELEPHONE <br />DATE <br />i <br />- , <br />- <br />r <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED <br />PERMITTEE NAME /ADDRESS (Include Faciliti \aozr /Lacatwo if Different) <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 />DISCHARGE NUMBER <br />YEAR <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 />