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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 />- <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />" <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />' <br />- <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />• <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />: s t'� <br />'`✓f <br />SAMPLE <br />MEASUREMENT <br />; <br />, <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that this document and all attach rents were <br />prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel pioperly gather and evaluate the information <br />submitted Based on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathering the information, the information <br />submitted is, to the best of my knowledge and belief, true, accuiatc, and complete <br />I am aware that there are significant penalties for submitting false information, <br />including the possibility of fine and imprisonment for knowing violations <br />TELEPHONE <br />DATE <br />c <br />/ ' <br />• ; p i ' <br />l ,' ; " <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 (Include Facility Name Location i/ Dille, ent) <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 editions may be used <br />FROM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER <br />YEAR <br />MO <br />MONITORING PERIOD <br />DAY <br />TO <br />DISCHARGE NUMBER <br />YEAR <br />MO <br />DAY <br />Form Approved. <br />OMB No. 2040 -0004 <br />NOTE: Read Instructions before completing this form. <br />This is a 4 -part form, <br />PAGE OF <br />