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f'ERMITTEE NAME/AUDRESS(/wr1~JrF«WryM~./Locarenl/D~Q~.w+q <br />NAME <br />ADDRESS <br />lux 1430 <br />~SAVL CU C15Lt <br />FACIIm ~iu~ hvitTii t; ~CUTH MZhE:; <br />LOGTION YALIS±~~~ CL n151E <br />NATIONAL POLLUTANT O{SCMAAOE EiIMINATiON SY9TEM NPDESi <br />DISCHARGE MONITORINt] REPORT ID Rl <br />PERMIT NUMBER ascNAROE NuMeEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />(SCdti ie) <br />F - F'I nAl ~ <br />'~" ii ... C PCi i+lV... <br />~_ .. <br />NOTE: Read Ir~struetlorw bafor~complatir-y thla form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• fl+E°oFNt:v SAMPLE <br /> <br /> EX 'r'rr~Y~s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT .' t ~ ~ t r' L Y 1-:~ ~a•r <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' """~ " " P`"•'r ° L. Ibu uN doo"meM ^nd JI •n.cbmenb were <br />TELEPHONE <br />{ <br />DATE <br />prtpared under iwr d <br />rertbn or twper.Now In oteord•nee wltb • arstem desl~ned <br />A <br />to mart t <br />•1 V".Hoed personnel properlT ntMr •nd ee•iu•le the Inrorm•Ilon <br />. _ . wbmlited. a.ed on mr Inqulr~ or tree person or presorts wlw m.n•te Ibe •retem, <br />.. or those penore dltxty reporrybk for p1bMn~ U+e Inrornullon, lbe InfornrUen _ <br />tubmlltM b>, to Ibe bet or m7 knowkd~e •nd DeMtf, lrve, tretu nte. sod tompkle. ~ - _ ~ <br />1 •m ^ort tbsl tbers •re tdptinont pendttn for wbmltNn~ (sbu lnr°rnuUon, 61ONATVRE OF -AINCIrAI EXECUTIVE y <br />TYPED ~ pp~~p lneludin~ the pesdblNir of one srd 1mpAtnnme"t roe tnowinT .ld•tlons OffICER Oq AUTHORIZED AGENT COLE NUMBER YEAR MO DAY <br />COMMENTS AND EXPL/tn~ } Ivn yr An T YIVL/~ 1 IVrva (h171/I/rCI M IrrIC/imlrr rJ Aa/I/ <br />~ ~ . , <br />EPA Form 3320-1 (Rev. 3;99) Previous editions maybe used I h!5 IS 3 3-pgrt fOf1T1. PAGE OF <br />• ~, i, <br />