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PERMITTEE NAME/ADDRESS (Indadc FacUily NaxclLAwdon ifDiffmar) <br />NAME <br />I NE <br />ADDRESS - C "� G -7 :%! -- — <br />Z. <br />FACILITY `4 oi! <br />LOCATION ;-4 C,= = <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM tNPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />Y� DAY I - I DAY - <br />FRAM TO YEAR I MID <br />2MI 0" 161F 1 74AA cf,�T 13-4 <br />Form Approved. <br />OMB No. 2040-0004 <br />T <br />y <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />OF <br />SAMPLE <br />EX <br />ANALYSIS <br />TYPE <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />SAMPLE <br />MEASUREMENT <br />'"NST <br />F <br />MUNITHI <br />SAMPLE <br />MEASUREMENT <br />R]JEOWREMENT, <br />SAMPLE <br />MEASUREMENT <br />PERMIT" — <br />REQUi8E1M9NT <br />SAMPLE <br />MEASUREMENT <br />.RE'o6REmEw—r <br />SAMPLE <br />MEASUREMENT <br />PERMIT- <br />AEOUIPAMENT, <br />SAMPLE <br />MEASUREMENT <br />,REOUIRENIENT•" <br />SAMPLE <br />MEASUREMENT <br />PERMIT' <br />. <br />REQFJIREINEI CT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER <br />i certify under pemity or taw that U94 d0VM%njt and all 2Lt2ChwwL, were <br />prepared under say idiroction or "pmNion in accordance with asysUm de4goed <br />to aNhure that qualified personnel properly XUL11W and MIUSAW the information <br />00, <br />TELEPHONE <br />DATE <br />Aler4:!�d5atl V, <br />gulunitted. Bated on my inquiry of the perqon or pmorm; who inamme the., ".nt, <br />or those, permno. directly respormilale roe guibcKnIg the information. the information <br />is. to the best my knowledge and b0hS, true. uccuruk- and complete. <br />submitted of <br />aware that there ungnifigunt penalficsfor submittiou falge inforniadon. <br />1 = .m <br />including the pos,ibility or fine and impri%opment. for kno-ing eiglatiorm <br />SIGNATURE OF PRINCIPAL EXEcu.,,E <br />0 AUTHORIZED AGENT <br />FACER OR <br />TYPED OR PRINTED <br />AR E;-A <br />CODE <br />I NUMBER <br />YEAR DAY <br />Fi 0 <br />COMMENTS AND MXPLANA I IUN VI- ANY VIULA I 14JI'llb (KeTffrenG4-- all a1wcnf"U1XF "Ural <br />r-,Z: :D SIJRD-=N <br />7, <br />&:Illy <br />EPA Form 3320-1 fRev 1/991 Previous editions may be used. CO 4 0 / -0 PAGE :-OF <br />