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PERMITTEE NAME/ADDRESS(IwoM4F•eWyNrr/L•c•n•wI/D(QlwswQ <br />NAME <br />ADDRESS <br />. SOX 14.3U <br />. ~ALc. CG b15~b <br />fACarrv Slflb 1:~iYTh E :;CJT~i t7iKE5 <br />LocATION FALISAD~ CC bi~16 <br />• 'iiiN 1 K7 i~~li.(. 1!_D_ <br />Form Approved. <br />NATION AI POLLUTANT aSCHMOE ELIMINATION Sr4TEM ((NPDES/ OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /OMRI <br />'-.:i n L d <br />PERMIT NUMBER ascHMOE NUMSE~ <br />MONITORING PERIOD ~ ~ • ~ ~ <br />YEAR MO DAY YEAR MO DAY <br />FROM TO _ <br />NOTE: Rra~d ImtrvcNorn b~lortibtMq thfs form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCr SAMPLE <br /> of <br /> EX ,wALrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />"_ <br />, , <br />~ <br />.. .. .., <br />_ <br /> REQUIREMENT <br /> <br /> <br />` SAMPLE <br />' <br /> MEASUREMENT <br /> <br /> PERMIT <br />•. <br />- <br />% ~• <br />_ / <br />,. ,. <br /> REQUIREMENT • <br /> r <br />. <br />~ <br />ti <br /> SAMPLE <br />" <br /> MEASUREMENT <br />_ PERMIT ._--*ct ~sv~•, i•~vr ..~.~_."; ,~~./ <br />~ ~n~ <br /> REQUIREMENT <br /> ~ \ 4 <br /> <br />` -`~ SAMPLE <br /> MEASUREMENT <br />- <br />~ <br />, <br />- <br />PERMIT <br />t <br />•v?l?t?ti,t <br />4tiO~~ei~. <br /> <br />~_ <br /> <br />i ...; ., <br /> <br />~• 1_ :: / <br /> <br />:, :, F. is <br /> REQUIREMENT 4• T r ,r• <br /> SAMPLE <br />~ <br /> MEASUREMENT <br /> <br />v PERMIT :. x -~ r::~ T. .=n. r <br />~ ~ 1 ' ' <br />. <br /> REQUIREMENT . <br /> ~ ~ , <br /> <br />` ~ y y SAMPLE ~ <br />• ` <br />~ . MEASUREMENT <br />'Tntthl't'ic:l~ ;' <br /> <br />r 1 ~ ~ PERMIT <br />. _.. " <br />., ~ F C h1' <br />~ <br />; <br />~ <br />_ . <br /> REQUIREMENT t . , <br />a.UL' ~ ~ ~ <br />` <br />!_ ~~ :. 5 r Z v . F. i, SAMPLE ~ <br /> MEASUREMENT <br /> <br /> PERMIT .._ .. ,:::,: pCi~? :~Git7 .- ~Y ;~r•.; <br /> REOUIREMENT <br />- <br /> i .,E., <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER ' et"''r ° r p•""r ° L. /h•! thh docvmewl •nd W •ItKhntmu were <br />TELEPHONE <br />DATE <br /> prep•rrd under n.~ dlrefl{on or tuper`hlon In •rcord•nR w{/h • t)tte,n dd~ned <br />_-, - to tmttrr u.t ~•.nnee perwnnei p.°gr.+r iuhr..nd r..w.lr the lnrerwullon <br /> rbm111ed. bred on ink inquiry or IAe pawn tx penorr who m•n•te the trttrm, <br /> or Ilfo•e <br />trsero dlrectl <br />re <br />ordbk f <br />lherlr <br />ln <br />I <br />r <br />h <br /> p <br />T <br />p <br />or E• <br />K <br />n <br />r <br />orm•tlen, t <br />e Infenn•llon - ~ ~ <br /> wbnilled h, to Ihr belt of m7 knowledge •nd btMe1. true, •(Y1l nlr, •nd tompklr. <br />• ~ _.. <br /> 1 •.n •.•,. ua mere .r. yrnmc.nl pen•Irlet rnr tubmll[In~ r•l. Inrnrm•un., EIONATURF Of -RINCIPAL EXFCVTIVE - ~ <br />TYPED OR PRINTED . <br />Ineludlnt the prvadhllitr or line •nA ImpASnnment fnr knn.lnr .tnlruoret OFFICER OR AUTHORI2E0 AGENT CODE NUMEiER YEAR MO DAY <br />COMMENTS AND [Arv~nn 1 wn yr nn a .tvt.n t tuna rrTrr~rmc~ an •rwcnm~nra nn~r <br />_ ~ , - , <br />EPA Form 3320-1 (Rev 3'99) previous edrtons may be used This is a 4-part form PAGE OF <br />