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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 certih unde, penally of law that this document and all attachments acu• <br />prepared under nit du ecton or tiup •n i.um m attoi danc cuth : »Stem designed <br />to assure that qualified personnel pr pet I. gather and etalnate the mho nnatum <br />submitted. Based on nut unpin') of 1 ie per son or persons Oho nit Rage the ,stem. <br />or those persons directly responsihh lot gathering the mlm niato n, the information <br />submitted is, to the best nl MN knowledge and belief. lino, au urine, and complete. <br />I am aware that there .tie significan penalties Ioi submitting false information, <br />including the pnxihdih of tine and unpi nunment for know mg cndah °° . <br />TELEPHONE <br />DATE <br />• <br />' <br />' <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />O FFICER OR AUTHORIZED E AGENT <br />AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED <br />PERMITTEE NAME/ADDRESS (Include Facility \arnellocanon tf Ihflelcm <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 />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 />