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Form Approved. <br />PERMITTEE NAME /ADDRESS (include Facility Name /Location if Different) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) OMB No. 2040 -0004* <br />MAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY <br />LOCATION <br />MONITORING PERIOD <br />YEAR MO DAY I YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />>< <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 />�'USPENDED <br />MEASUREMENT <br />? 0 O <br />PERMIT <br />" <br />ROSS fir, <br />REQUIREMENT <br />_,_.. ._... i-. s + .F. A 13 L t-- <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />GTAL RECOVERABI_F <br />o`?80 ). C; v <br />MEASUREMENT <br />" <br />PERMIT <br />- F•F'I_JJFNT GIRCISS VAII -t; <br />REQUIREMENT` <br />�. # <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />Fes' l.1Fl <br />REQUIREMENT <br />SAMPLE <br />i i 7t i1 J*R -e- i i`t"i'a i i "n Fif', <br />MEASUREMENT <br />10050 1 €a' <br />PERMIT <br />FFLUEhty "r> ` c' `'; i .' <br />REQUIREMENT <br />V55, <br />SAMPLE <br />I SSOLV "~.I.J <br />MEASUREMENT <br />0295 1 f3 0, <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certil :'I trader penalty of law that this document and all attachments were <br />prepared under m} direction or supervision in accordance with a system designed <br />to assure Thal 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 />- <br />r _ <br />TELEPHONE <br />DATE <br />„�' <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />1 am aware that there are significant penalties for submitting false information, <br />including the possibility of fine and imprisonment for kno sing violations, <br />�G, `o: 5 �. ,, <br />'z <br />TYPED OR PRINTED <br />AREA <br />CODE <br />NUMBER <br />YEARI <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320 -1 (Rev. 3/99) Previous editions may be used. This is a 4 -part form. PAGE OF <br />