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PERMITTEE NAMEIADDRESS17^"i ewryNoodLor.ri w((Dl -vw) <br />NAME <br />ADDRESS <br />i3 J h. 1 i ,? V <br />FACILITY BADS I D NORTH & SLEUTH M: <br />LOCATION R PALISADE Ci <br />L SON t.. K I DUER) V. P. <br />NATIONAL POLLUTANT 04SCHAAOE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D R/ <br />PERMIT NUMBER asCHAROE NUMBER <br />MONITORING PERIOD <br />YE MO DAY YEAR MO DAY <br />FROM TO <br />Form Approv?,d <br />OMB No 2040-0004 <br />NOTE: Read imtnwdone before complet"" form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />E OF <br /> X ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> - <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TME PRINCIPAL EXECUTIVE OFFICER 1 «rtty . r pen. y e I.. that thh document and all stt.chments were <br />TELEPHONE <br />i <br />i <br />DATE <br />prepared under my d <br />on or suPer+Ision In accordance with . sTstem darned <br />rect <br />to emure I%" qu.Nned personnel properly gather and rr.lu.le the information <br />i 4 submltied. Bored on my inquiry of the Person or persons who man ire the system, <br />1 <br />, <br />i =t " <br />L <br />ma <br />. <br />. <br />or those persoro directly reporsible for gathering the Information, the information <br />e e ' c ` <br />x- <br />G •-"" submitted Is <br />to the bat of me knowled <br />e and belle! <br />Iro <br />or <br />rste <br />_ <br />nd com <br />l <br />t <br />-- <br />. <br />, <br />g <br />c. <br />. <br />n <br />ru <br />. a <br />p <br />e <br />e - ) .. <br />t ...... that there .re :lgmnr. l P-lfles for rubmlttiet W- tomrm.llon <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED , <br />ixlvdin>; the P?bilitr or nix .oaf 1,Prlsnnrnent fo knowlnc .lot•ti <br />o,? OFFICER OR AUTHORIZED AGENT CAREA ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference thl attachments hPre) TO'f <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />PENDED SOLIDS (TSS), TOTAL IRON AND/OR <br />34 / '-T-his is