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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 cef lift nmlei penalty of lino that this document and all attachments " ere <br />prepared nndei nit du return or sup `reismnl in au ordance eith a sv stem designed <br />to asuf e that qualified personnel pr gterly g: thei and evaluate the inlnnmauon <br />submitted. Based on nn MIAMI of the person of persons vvho manage the system. <br />of those persons <11 et.111 responsible for gathering the inhumation. the information <br />suhmdted is, to the best of MN' Anualedge and behel, trot., accmrate, and complete <br />1 am amore that the, sue signdieant penalties for submitting false information. <br />ux luding the possibdrh of line and imprisonment fm Isnmt mg violation,. <br />TELEPHONE <br />DATE <br />• <br />. l <br />•, <br />• <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED <br />PERMITTEE NAME /ADDRESS (Includr Facdhtt \a,oe /Lacanan f/ Jefferentl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 />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 />