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PERMITTEE NAME)ADDRESS(yneirb Facilry NawsJLecrfoe((D(ej) <br />NAME <br />ADDRESS _ - :: • ... <br />. ?. OOA 14 3(! <br />rSAD . co bltl. <br />LOCG'AT)OS , , -JIDL NUhlb L' SOUTH I;INES <br />L - PALISADE CC bi::,z <br />(I .1d 1 _ KrnI;FT. V-D. <br />Form Approved. <br />NATIONAL POLLUTANT OISCHMIGE ELIMINATION SYSTEM ((NPOESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER OtSCHAAGE NUMemR - F1 N A L P e S A <br />MONITORING PERIOD SIC CGLO h A L C I' V[ F <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Ramd Inatructlorr b4.fora enm Latina 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 /> r r a :{ di C I~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />MCN'Ih <br /> SAMPLE t <br /> MEASUREMENT <br /> PERMIT <br />R ::mar: >KNttk>:?J? r:Y4"' ?;t i,T 11.c/ i.rsE' <br />r : li :..: ; EQUIREMENT T . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT gtplt; r. ti>ssct,)+=- +: d>?t 4 <br /> REQUIREMENT <br />. 1, ' 1? {: i? <br />at i lA <br />?? T F <br /> SAMPLE <br /> MEASUREMENT <br />_ PERMIT <br />REQUIREMENT <br />y <br />r I' <br /> <br /> SAMPLE <br /> MEASUREMENT <br />V _ v PERMIT r.PGr:: StEPO it T <br />' REQUIREMENT <br />L U E N <br />1 ct0_ :. <br />n I L Y <br />_ A N _ .. '. A. ? ,. SAMPLE <br />_ MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEfnnE PRINCIPAL EXECUTIVE OFFICER t nruty under penalty o law that thb document and au atlachments wen <br />TELEPHONE <br />DAT <br /> Prepared under my dlnctlon or wper+hlon In accordance wllh ¦ system darned E <br /> <br />. to asSun that quanMd personnet Properly gather and t-Nole the Information <br />Submitted. bred on my inquiry of the person Of Persom who manage the s <br />stem <br /> y <br />, <br />or than <br />ersts directl <br />m <br />onow f <br />lh <br />rl <br />th <br />r <br /> y <br />p <br />p <br />or ga <br />e <br />ng <br />e ln <br />ortnallon, the Information _ <br /> Submilted b, to the best of my knawiedge and belief, Irve, atcvntr, and complete. <br />I am swan that then an slgnlnnnt Penalties for Submllting robe Inrorma/lon, -- <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br />TYPED OR PRINTED 1'+rluding the Possibility or llm and Imprisonment for knowing Nolsuont. OFFICER OR AUTHORIZED AGENT CODE NUMKR YEAR MO DAY <br />?.vmmus t? ntsv ?... v,.......,.. -. .?... _.__...._.... ... w. w. ., .... .., w..w....rrw..w n.r ., <br />.,,24hh PRECIP. LVENT CCCURS, SUBjEC1 IC tLELZb CF PFCCF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. , This IS a 4-Part Orin.