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PERMITTEE NAME /ADDRESS (Include Facility Name /Location if Different) <br />NIA ME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR I MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040 -0004 ji, <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />>< <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NQ, <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 />Jy,i'ENiJ� D <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />J <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />ib UL.vi.i, <br />MEASUREMENT <br />0 c'C?5 1 t-' `) <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I ccrlil'y under penally of law that this document and all attachments were <br />prepared under my direction or supervision in accordance with it system designed <br />'"` - <br />TELEPHONE <br />DATE <br />/ <br />to assure that qualified personnel properly gather and evaluate the information,_.... <br />submitted. Rased 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 />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />P f� <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 violations. <br />- <br />TYPED OR PRINTED <br />AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />L-0'! � 3 ii L. +. L;J :. ! w r} % 1 1"i tt i' "' K L �.r' �'a �. i'vt i;.,; u ..i 1~ `,. i I Lf is 1.; f'� 1, t..=. i'N M.1 t (� � t _: = c c •. i:. ^s i a.: �.1,:.. . _.. � ..� .. <br />ANY ADDITIONAL DATA SHALL BE .SUPPLIED TO THE DIVISIC)N WITHIN 48 'HOURS. <br />This is a 4 art form. PAGE OF <br />EPA Form 3320 -1 (Rev. 3/99) Previous editions may be used. h <br />