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I PERMITTEE NAME/ADDRESS t/ndude Facility" A'antdloraNon iJlhfJaoui <br />NAME <br />ADDRESS W HOR I ZG~"•• M I <br />:1. 8r~n .:.~5 <br />,_) <br />FACILITY t-#~jR j Z~ Mi <br />LOCATION <br />'+ICE Wr,L~~: <br />CC3 ~I4~ <br />IAP3AGEF~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESJ <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEA MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />' ^' <br />NOTE: Read Instructions before rmm~latina this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT ., _ .. -, - <br />. REQUIREMENT M I i I ` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t:. ~ r- ~ ;- t~ ,, ., _ . <br /> REQUIREMENT _ PI % 4 ,. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT J- ._ , <br /> REQUIREMENT Cr. i'• ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. - . ~- s- ,:.. ~ _ ~:. , ., <br /> REQUIREMENT ~+r-1 AVG G+ , hi~i`~i i :- <br /> SAMPLE ' <br />_ MEASUREMENT <br /> PERMIT ... , .;. - _ , <br />~ .. <br /> REQUIREMENT - -. r; =-, 7 ; (. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT >; _ .. - :. ~ .. - - +_ .. <br /> REQUIREMENT _ ..- ' . I <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ ... 1 >• .- .- : .. ~... <br /> REQUIREMENT - - -- <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I cerGr~ under prnalt} ul luM that the+d+wurm•m an<I au attarhmeat. were - TELEPHONE DATE <br /> prepared under my dirratiun nr +upen-isinn in aati~ordunre with a ~~riem dr+i>;ned _ __ <br /> to ¢s.urr that goaliGad prramtx9 properly Ralhcr and c+aluate tlrc informmion i <br />~ _ .ubmitted. Raid on my inquire of the prnnn nr prnan. whn mrwpr the +y Nem, <br /> or thox per++ms dira~cuy re+prmibir fur ttatherinu the inGxmatlnn. the iaformatiun ~ ~ _ <br />~. .. __ <br />/ +ubmitled t+. w thr fa•+t of my know ledttr xnd hellr f. Irtx. accurate, and cumplelr. <br />I am aw arr that the <br />e <br />+i <br />ifk <br />m <br />h <br />l <br />i <br />f <br />i <br />f <br />f $IGNATURE OF PRINCIPAL EXECUTIVE ~+ ' ~ _ f~ 1 ~ Z <br /> <br />TYPED OR PRI TED <br />..ruTC w~+n cvn+ w + nr wuv v+n+ r <br />arc <br />gn <br />r <br />pena <br />t <br />es <br />ur +u <br />mNt <br />ng <br />uhr in <br />ntmatiam, <br />irnludh+K for pus+ibilin of firrc and impri.nntnent Lir km+wln~ vhdations. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />D <br />YEAR <br />MO <br />DAY <br />a,vmmur.v nna, enrt_ri rv eattvt~ yr Mnr rtvt_r+ttvt~J (nC/t'IClIGC d!! HllHt:flfflBflfS f)@l'@f <br />-.~~ <br />EPA Form 3320-1 (Rev. 3'99) Previous editions may be used. <br />)044; Thic is'a'4-dart fnnn. <br />