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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 />- ' <br />= <br />"� <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />` <br />i <br />'''{ <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />% <br />-_ <br />- t'- '' <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />- <br />, '"' <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />t i <br />- <br />I <br />.,..,..4.\i <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that this document and all attachments were <br />prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel properly 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, accurate, 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 v iolations. <br />- • -' <br />TELEPHONE <br />DATE <br />• <br />•. { _ <br />v <br />jC I ' <br />- - • <br />! <br />` <br />1 <br />-" <br />+ <br />7 <br />7 <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />AREA CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED <br />PERMITTEE NAME/ADDRESS (Include Facility Name /Location ( Different) <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 NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 />