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PERMITTEE NAME/ADDRESS ply F.etMryN~w/Locwrow (/DfQGrw.rJ <br />NAME <br />ADDRESS ,~ <br />b U it i v ,i L~ <br />.jADc. C.U ti~l <br />FAaLm <br />-~iDE !1~):•,ih ~ ~uUTk! ,^}iVi;S <br />LOCATION <br />NALISAL;. Cu b15~ <br />~~.-..~ u , ,.. .. <br />NATION AI POLLUTANT 01SCMAROE ELIMINATiOM SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D~R1 <br />PERMIT NUMEtER ascHAnaE NuMeEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />- FZ hAl <br />FLyU ~ TC CCLCF.~ <br />Form Approved <br />OMB No 2040.0004 <br />n:V~rs <br />~ _: ~ <br />NnTF• a..a t.....:~...I..... ti.r,.....,....,~.t.... ,tit. ~.,..., <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. CEO <br />F~~~ SAMPLE <br /> ° <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAtr~s TYPE <br /> SAMPLE <br /> MEASUREMENT ~ ' <br /> PERMIT <br />REQUIREMENT .. ~ . ~i .:... ~ .:: ; .. it <br /> . ,. ' • b , <br /> SAMPLE <br />' <br /> MEASUREMENT <br /> <br /> PERMIT _ <br />~ ~~ <br />~ ` ~ <br />~' <br /> REQUIREMENT `` <br /> 1. <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT ~ -, .. i; i. i L t, '1 ?+ C ;: / <br />` <br /> REQUIREMENT <br /> _ - ~ d y Y <br /> <br />f ~ ~ SAMPLE <br />~ ~ <br /> MEASUREMENT <br />~.. <br />, <br />_ <br />PERMIT <br /> <br />`' ` Y ' <br /> <br />~ ~ ~ li <br /> <br />i L' <br />l <br /> <br />~ . <br /> REQUIREMENT ~ / . 1:. <br /> 4 ~ <br /> SAMPLE <br />` <br /> MEASUREMENT <br />_ PERMIT <br />" "~` <br />; c. i C <br />4 ,~ : <br /> REQUIREMENT . <br /> <br /> <br />' ~ SAMPLE <br />I <br /> MEASUREMENT ' <br /> <br /> <br />_ PERMIT <br />., i <br />. r C n T' <br />- ... <br />.,i s..i -, <br />.. <br />_ , i ~ ' ,- ~ <br />r <br /> REQUIREMENT <br />' <br /> <br />~~ SAMPLE I <br /> MEASUREMENT <br /> <br /> PERMIT ~ .. :. .r ., r~• ~ . <br />. ` .y. <br />n' <br />~ <br /> REQUIREMENT . <br />_ <br /> <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' fe""r " ei Pr""r ° 1•" In•t Wh docvmrnt .nd .M .tt.rhmrnu +rre <br />d <br />l <br />TELEPHONE <br /> <br />DAT <br /> R •re <br />tlndlr Te d <br />rrflbn of w <br />v v off.yen In .ccord.nr. +Itn ..rttem da![nea - E <br /> to mutt Ih.t qu.Mfkd prrsonnet proprrir [.tMr •nd e.wu.le thr Infornullon <br />.tlbnrtted. e.sed on mr Inquiry o! tlx Peron or penoro +Ae m.m[e tAe .ystrm, ' <br /> or lbo.e Penote dlreclly re.po~bk for [.Ibertn[ tAe In-orm.llon, tAe Inrorm.llen <br />b r <br />~ ~ <br /> w <br />mitted b, 1. the bell of mr Lnow4d[e .nd brne(. trot, .cfur.te..nd mmpkte. <br />I.m .+.re U.t tbm .r d[nlnnnt Pen.ltb wr rubnrtnn[ r^be Inrn.,n.uon, -- <br />EIANATURE OF -AINCI-AL EXECUTIVE i <br />) <br />~~ ~ ~ l/ <br />- Q <br />TYPED OR PRINTED <br />--. ..._..~_ ..... ~.,... .... ,... .,r ..tv tttr,~ t^~~n[ ~~+• po.swntr ornne.nd IrnPA.onment ref tno+Inc .+e+•uw.t <br />.~~f,.~.. . .. ._... OFFICER OR AVTHORI2ED AGENT CODE NUMBER YEAR MO OAY <br />EPA Form 3320-1 IRev 3'99) Previous editions may be used TIIis is a J-part form. PAGE pF <br />