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PERMITTfE NAMEJAD[7F1E55(/writJef«iflyNw~~Laewar l/D(Qirwr) <br />NAME <br />AIxMESS <br />.. ii~X _ ~F.:iU <br />SAD C.I <br />FAdLITY ; 5 T DE NORTH °: 50~{Tli M <br />L~,L,~ ~; PALI5AIIE CI <br />'_50N I_. ~cII?I:IEP, ~. P. <br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM NPDESI <br />D-SCHARGE MONITORING REPORT f0 Rl <br />PERMIT NUMBER aSCHMOE NUMEEN <br />MONITORING PERIOD <br />YE q MO DAY YEAq MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />_ ~ • <br />r~ '~,L <br />NOTE: R~~d Ir>•trucUorn b~loh complytiny thl~ form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> of <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />~~` <br />~ PERMIT -~ <br />~i l~ r.,; ; ' ,-_ REQUIREMENT . i : , r ~ _ 'h~l Y' I MI,_'"' <br />-~ SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT ~ . d~ i ;`~ =, • ;i: ! <br />_ _ SAMPLE <br />~1 ~ MEASUREMENT <br /> <br /> PERMIT <br />"' REQUIREMENT <br />x: ~ "ilJ(,-. t <br /> SAMPLE <br /> MEASUREMENT <br /> - i - <br /> PERMIT <br /> REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PER MIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' rert'y u er pen, y o h. th,t tfJf decurrrrnl ,ne ,p •u,chnrnls .ere -- <br />TELEPHONE <br />r <br />, <br />ed u <br />d <br />dl <br />tl <br />l <br />- <br />DATE <br />p <br />rp <br />r <br />n <br />on or aperv <br />er mr <br />rrc <br />slon In ,ttord,nce nltb ,system destLned <br />le nsure IhN ~u,Mfkd personnel ProPe~l Vlhrr ,rW erNU,te the Inrnrtn,lbn <br />I ~ /1 if r. .~ abmittee. bard eo m7 I~pulrT o! the person or persoro ~Aa msn, <br />e tfre s <br />stem <br />' <br />~ <br />L <br />y <br />. <br />If /Lu . ~ , <br />_ <br />n <br />th <br />r <br />dir <br />tl <br />re <br />rrdbk f <br />' <br />~ <br />" <br />r <br />ose pr <br />stm, <br />ec <br />y <br />rpo <br />or L,IhrrlnL the Informsllon, the Inrtuntstlon _ <br />~ - - - c, <br />r-)/~ ~; , ~ <br />~ <br />L <br />. tubmlltrd h, b the best of my kwo+rkdLe ,nd btMef, trw, ,rrunle. •nd tvmpkle. / , <br />) __ <br />/ <br />t •n. •.sre th,l mere ^re Il(rdflc,nl pendda fer abmltHnL hlsr Inronrr,tlnrt, !<IONATURE OF PAINCfIAI EXECtITIVF <br />TYPED OR PRINTED InrludlnL the pwdDltlly dflee,M ImpMenmenl for knoulnL .lel.timre OFFICER OR AIrrHORIZED AGENT ~~ NUMEfER YEAR MO DAY <br />GVMMCrv t J AryV Cnr~nnr-I rvrs yr n ~ vvn ~ runs rntrrtrrrrgcP mr r.rr~curnr/nv ntsrq <br />~lr <br />- -=- ~'. <br />ENDED SOLIDS (TSS) , TOl'AL I I~QN AND <br />EPA Form 3320-1 (Rev. 3199) Previous edrtio~s may be used OLEO ~ 1 ~I1t~ 13 ~' d=part form. PAGE Of <br />