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PERMITTEE NAMEIADDRESS(/.eYiFarebryN?r?leraetawl/D?inwrj <br />NAME <br />ADDRESS , <br />). MUX I4.3U <br />i,i5ADr. CO dlt)L <br />FACILITY .,DSIDE NURTh G SOUTH RINLS <br />LOCATION AR PAlaISADL' CC d151 <br />. I C /a u t der r" t. r <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /D RI <br />PERMIT NUMBER DISCHARGE NUMBER <br />- FI K AL <br />Mc_;1V <br />MONITORING PERIOD IC CG LC n A Li b 1 V <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE- RsaA In.tnte New h.1-. -hI.tlnn this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />j <br /> REQUIREMENT • <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT 1 J / <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ??tG:?sll? r':: rYCr i t: i/ raL <br /> REQUIREMENT ?• 1 ;t 'f i <br /> <br />e SAMPLE <br /> MEASUREMENT <br />J PERMIT :- :. ;, :? •. ... <+ ; <br />7 ti v v <br />', r. <br />/ <br /> <br />- ' <br /> REQUIREMENT <br /> - / <br /> SAMPLE <br />j <br /> MEASUREMENT <br /> PERMIT <br />- -77 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />.. PERMIT <br />;._tC: <br />4, IQ <br />c 'LY <br />i*• <br />'i <br /> REQUIREMENT , <br />_ <br /> <br /> SAMPLE <br /> <br />_ MEASUREMENT <br /> PERMIT <br />i <br />- <br /> REQUIREMENT <br /> i <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 'fen"Y pe"' tr ° law that thk documrni and all allwitmnns were <br />TELEPHONE <br />DATE <br /> prepared under my dlrerllon or sup-Won In arcordanm with a System designed <br />_ <br />I to inure that quaMMd personnel propeAt pltw and evaluate the Infornrlbn <br />itt <br />d <br />b <br />E <br />d <br />I <br />I su <br />m <br />e <br />ase <br />. <br />on my <br />nquiry of the person or persons who manage llw sntem. <br /> or Ihow persona directly respandbk for gathMng the Informatim the Inform.tl°n <br /> submilled k, to the best of my knewkdge and belief, true, a rwle. and complete. <br />r <br /> 1 am aware that there are signilleant penaldea for submitting fake Information. SIGNATURE OF PRINCWAL EXECUTWE ' <br /> <br />TYPED OR PRINTED <br />Inrhrdint The poodblEtt of floe and Imprlxmmrnt for knowing violatlorn <br />OFFICER OR AVTHORIIED AGENT ARF <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />t.UMMCrs l J Mild <br />., - EVEN, <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is 1 4-paCl form. PAGE OF