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PERMITTEE NAME/AODRESSp+.rvbF.erMryN~./Loerra.{/D{~,nw.y <br />NAME <br />ADDRESS ' <br />_ . ,. ;ion lv.~u <br />~.IS~tDL cc ai~. <br />FACILITY D;;IDE HUATd E SCUTH MZltE~ <br />1OG'~ xri PALISADE CG 1315: <br />r1.S{iN I KTP.t1iG v_D_ <br />Form Approved. <br />NAnoNAI VOILUTANT DISCNAROE ELIMINATION SYSTEM //NPDESI OMB No. 2oao-oooa <br />DISCHARGE MONITORING REPORT /DMR/ <br />.., . <br />l ~ .. ~*) <br />PERMIT NUMBER lrscNAnoE NufwleEA _ F I K A L M E S S <br />MONITORING PERIOD ~ n U 1 G T C CC A L C F E L K <br />YEAR MO DAY YEAR MO DAY _ <br />FROM TO ~~ <br />NOTE: R~fd Irt.trvctior+~ b~ltx~ CtimDletfny thb form. <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. fREOUENCV <br />SAMPLE <br /> oc <br /> EX ANALr~s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />~ ~ <br /> MEASUREMENT ' <br /> PERMIT <br />~ - <br />^ <br />T <br /> REQUIREMENT ~ _ _ <br />r: ., . . <br /> o-• - ~ w <br />v <br /> <br />` SAMPLE <br /> MEASUREMENT <br />~~. •. 1 ., ~, PERMIT ~ - :;r.rCr.. . ~ 4~.'r/ ; , _ <br /> REQUIREMENT . <br />, _ <br /> , r <br />~i_ r .r .. ~..-... <br />SAMPLE <br />1 <br /> MEASUREMENT <br />_ PERMIT ~ ~ ~' ~'S V X' o .''i~~1 ~91<:. :; C r :. i• : _ ~ C. A T i ~ ~ r n i <br /> REQUIREMENT <br />• <br />., , ._ ., l V ~ SAMPLE <br />r <br /> MEASUREMENT <br />~, PERMIT .. ..c•:rr:i n:.ivkT r'4r': .. '~~44,~" i~.iY -i~",:h; <br /> REQUIREMENT <br />_ _ <br />, . <br /> <br />• SAMPLE <br />( ' <br />hL <br />MEASUREMENT <br />~f i 0 .. PERMIT - - :IrCNI Y .. - ~9~r; ~. :r. ,_..`.i,r•; I SIY v <br />T.,f~n <br />y.r ~ {J` REQUIREMENT , ,, ` _ ~, _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMEN•C <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE Of FICER 1 Krt1i~ Y rr yen. I) f Lw thft thh dnrvmenl fnd fll fllKhmenlf wtR <br />TELEPHONE <br />DATE <br />prtpfred under rn~ dirrrtlon a fuper+hron In fKOrdfnK with f stftern desl~ned <br />-' <br />to fame thfl ~ufNMd personnel Proper!/ tflher fnd erfiufte IM Inforrnfllon <br />b <br />t <br />~ <br />li <br />l <br />no <br />ml <br />ted. <br />ved on m~ Inqu <br />r) or the person a perforo who mfnge the intern, <br />or thole penorn direct!/ repord bit fa ptherlrK the Inrormftlon, the Infamftlon <br />fubmitted b <br />to tht bnt of m <br />kn <br />wted <br />d b <br />tl <br />~ <br />, <br />~ <br />o <br />~e fn <br />e <br />ef, true. fcrorfte. fnd complete. ~ - <br />1 fm ^wfK thft there fK d~Nnont penfltln for abmlitln~ !flee Inforwrtlon <br />fIONATLIRE OF -RINCfPAI EXECUTIVE <br />TYPED OR PRINTED , <br />1^ctudl^L the pavfblut~ of floe foe ImpMonrnent fa knorlnE Hditlorr>. OFFICER OR AUTHORIZED AoENT CooE NUMBER YEAR MO DAY <br />(iVMMCPIIJ ^ryV Cllr ~nrenrrvre ~... .•.+r.-...vrf.a In.r fr .ncw rr r/ntrwnn.nra rrtprq <br />. .. . ...:... _. .. .. -: .. ~ .• FAiCIP. EVi1~T GCCUn5, 5U 8JECT TC rGFCEN CF k6CGf <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. J ~ - ~ This is a 4-part ~'orrn. <br />