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PERMITTEE NAME/ADDRESS(I..~rF.rrbryN../Leerlewl/D~b.wn) <br />NAME <br />ADDRESS <br />DUX i4.3U <br />_~AUc <.Li n151o <br />FAC-Lm <br />LocA TioN ' S i U r. ti .1 i• i n ~ S U U •I H :7 I 'I !~ :, <br />PALi.iAL~ CU ti151b <br />NATIONAL POLLUTANT aSCNAROE EUMINATION Sr3TEM NPDESI <br />DISCHARGE MONITORING REPORT /D R/ <br />PERMIT NUMBER ascHnxoE NuMeER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br />(SiJbn GfA) <br />F - FI hAL <br />Y(i:li 1 IG CCtGh6LC 6IV~t <br />NOTE: Rr.rld Imtructiorw b~ftx~ ~ornpbtlnp this tofm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, Fneo <br />uFNCr SAMPLE <br /> ~ <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALrsls TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br />_ PERMIT <br />REQUIREMENT <br />• b <br />• `, <br />~ r ` ' <br />- ` ' <br /> ~. ; <br /> <br />' -~ SAMPLE <br />' <br /> MEASUREMENT <br /> <br /> PERMIT <br />- <br />1 - <br />:~ ~_ _ / <br />; r ~.:. <br /> REQUIREMENT <br /> I r .. <br /> SAMPLE <br />~ <br /> MEASUREMENT ' <br /> <br />_ PERMIT <br />x. ;,•... <br />...~,.,.. <br />tr.. <br />•. F..I,r i <br />' <br />`plc/ <br />'r%c <br /> REQUIREMENT t 1 M ~l ,r <br /> SAMPLE <br />( - <br /> MEASUREMENT <br />~.. ) <br /> <br />- '' PERMIT ,.:.r~x,,..: a.~:rr. <br />" ~ ~ <br />~ ".; - <br />(. C t: / <br />' ~ ~ ~~ <br /> REQUIREMENT <br /> .~ <br /> <br />' SAMPLE <br />' <br /> MEASUREMENT <br /> PERMIT <br />`. ~.I ,. <br />.. ~ r G : ': . <br /> REQUIREMENT <br /> ~, . <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />.. PERMIT <br />` ~ <br />~ t ~ ... ~•,•. <br />1 r <br />. <br />- `~LY i~ <br />,:n' <br /> REQUIREMENT - . <br /> <br /> <br />r ~ ~ ~ SAMPLE ( <br /> MEASUREMENT <br />PERMIT - ; ,- : - :; i. t G : C n <br />- <br />REQUIREMENT <br />i+ r. <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I Krtll] Y r pros y o b. thu Uy donmem .nd dl stt.ch1nenu +en <br />TELEPHONE <br />DATE <br />pnpsred under m~ dlrectlon w fYpervhlon In tY:eordsnn +Ilh a s~stetn Oesl~ned <br />_. _. to s>sYn lhsl qusMfled personnel properlf L.Iher sod e•sluslr IM Infonnstbn <br />>,Ybnrttee. ts,.re en m l w of the non w <br />7 nq 7 pe persem rho ms,tste ll,e e <br />tlem <br />~ <br /> <br />~ ~~ ~ J <br />. <br />w those person dlrectl~ rnpo~rd ble fw ~slhrAn~ the Infor,nstlon, the Inforrnsllon _ ( <br /> <br />~ I <br />r _ wbmtlttd b. b the bell of 11r1 kno,•kd[e sod brNef, Iroe. .tcvnlr. sod compkle. <br />1 srn s~sn Nst then sn rliNfk~nt pensltta fer nYDnr1111nN false Informstlon <br />-tl(~NATVRE OF -RINCIrAI EXECUTIVE _ <br />~ :.~ <br />- <br />TYPED OR PRATED , <br />InAudlnt the posslb1111T of floe sod Imprtsonmrnl iw knovinN .Idstlort< OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />ANU tJC 1'L.AfYA 1 WN Vr nn r ~ <br />nrrr~l <br />EPA Form 3320-1 (Rev 3f59) Previous editions maybe used. This i5 a 4-Pdrt ~OFm. PAGE OF <br />