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PERMI'ME NAMEIADDRESS(7nc&*FadkyNw.'Loeest (fDWwb t) <br />NAME <br />ADDRESS ... ,• .. _ <br />J. bUX 14JU <br />LISADL CU b15Lb <br />FACILITY ADS1Dk NORTH b SCUTH MIKES <br />LOCATION kit VALISADd Cu b152b <br />t.`i(IA I _ l(Tr:GFt,_ L_r_ <br />Form Approved. <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTUA (rNPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMRI <br />.. _ n ) <br />L) <br />PERMIT NUMBER aSCHAROE NUMBER - F I N A L r[ S <br />MONITORING PERIOD s D 7 IC CG LO h A L C h 1 11 i F <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ? .1?, <br />NOTE: Read kt?trvctlons before cofndl?tina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />r c <br /> REQUIREMENT <br /> <br />L SAMPLE <br /> MEASUREMENT ' <br />_ j t, PERMIT 111 1T•:0 i• .. ;;:as?>7?C ar y. c r L n 1 JO : <br />,1 s r <br />t <br />nU s 5 REQUIREMENT _ . . <br />j) U I a ?. SAMPLE <br /> MEASUREMENT <br />O11 PERMIT :tatty' :tUt': OaM;?u' <br />` <br /> REQUIREMENT <br /> . v Z <br />L;AiLY <br />A a SAMPLE <br /> MEASUREMENT <br />f PERMIT s? L F C h 7 =_ h L Y 1 , ;: <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />NAMEnME PRINCIPAL EXECUTIVE OFFICER 1 fen"' ° er penalty o I... that this tl t rnent and an anachmenb were <br />TELEPHONE <br />DAT <br /> .red under m direction or su <br />DreP 1 pereMsloa In ateoedante with • srlem dtsijned E <br /> <br />-Tr to assure that qualified personnel property j-lher and evaluate the Information <br />subrrnitted. Based on my Inquiry of the person er persons who manage tree system, <br />th <br />l <br />i <br /> or <br />ose persons direct <br />y respons <br />ble for gathering the inforsnatson, the information <br /> <br />' ' - submllted kL to the best or my knowledge and belef, true, ec'turste• and complete. --- -) <br /> t am aware that three ¦m significant penalties for wnbmittlng rater Information, SIGNATURE OF PRINCIPAL EXECUTIVE L" <br />TYPED OR PRINTED Intfudint the possibility of fine and imprisonment (of knowing Aolallors. OFFICER OR AUTHORIZED AGENT <br />AREA <br />ODE NUMBER <br />C <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />"F.,[u.. PFFC?I. V ., '1 CCC'' !7 :C,-- JLC': ECT;.rk C. rEt!.F <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-PBTt fontn. PAGE OF <br />.. I s_ L 1. .- .. a. ? y