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PERMITTEE NAME(ADDRESSQaekr4f e+BryNso.dLacrtawl/D(&.w.q <br />NAME <br />ADDRESS _ _ . < . <br />bOx 14iij <br />AUG. C i1 b15? <br />FACILITY <br />LocATtonON PALISADE: CC b15,g <br />-ON i._ Kif:GFk_ V_L,_ <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI OMB No. 2040.0004 <br />DISCHARGE MONITORING REPORT ID RI <br />PERMIT NUMBER aSCHARGE NUMBER - F j h A L C t .`tA <br />MONITORING PERIOD I NO 6 IC CC A L C Fi F E K <br />YEAR MO DAY YEAR MO DAY ??`/ <br />FROM TO X t <br />NOTE: Road kntructlone ba1w?coMolodng thlo form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX I <br />ANALYSIs TYPE <br /> SAMPLE <br /> MEASUREMENT <br />y PERMIT <br />a t Ir tr A- <br /> REQUIREMENT <br /> <br />Lj SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 1, CSI <br /> <br />f - _ . REQUIREMENT <br />aILV 1. <br />('Cwt <br /> SAMPLE <br /> MEASUREMENT <br />L ? PERMIT <br /> REQU <br />IREMENT <br /> <br />q AV <br /> <br />i C ail <br />r. SAMPLE <br /> MEASUREMENT <br /> PERMIT . •- <br />U i <br />: T REQUIREMENT <br />• <br />t ;a S T is <br />- I <br />;t <br />`. SAMPLE <br /> MEASUREMENT <br />V Jt- 1 J PERMIT LiUh'i , LY b <br />' 2r.: <br /> <br />rL?. .. Y. REQUIREMENT <br />.r. ., <br />_KItY ? r _ <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT j HT <br />REQUIREMENT . AN <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER ' cen ty under penalty .(I.- that thh docomenl and all attachments wrre, TELEPHONE <br />prapaned Yndor my dlrectl" or sopentslon In accordance with . system designed DATE <br />_ <br />. to assort that quaMfMd perwnnei property gather and e.¦lu¦le the Information <br />fubmltled. Bawd on m Inquiry of Me rsort or <br />y P< prrsors who manage the system, <br />! <br />-- ,,hose persons directly mponlbk for <br />atherin <br />th <br />I <br />f <br />ti <br />th <br />f <br /> g <br />g <br />e <br />n <br />orma <br />on, <br />e In <br />ormodon <br /> submitted Is, to the best of my knawiedge and bellef• Init. accurate. and compile. <br /> I am wars that them on significant ismallla for sobmltung takes Inrornrtbn fIONATURE OF PRINCWAL EXECUTM <br />TYPED OR PRINTED , <br />In.ckWlng the possibility of floe and imprisonment for knowing eidatloru OFFICER OR AUTHORIZED AGENT <br />AREA <br />ODE NUMBER <br />C <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />(:UMMCPf 11 ANU CArL^Fl^ n nvra yr na wars 1 sons fnsrsrsncw wr srucnmwrta nsisi <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This IS a 4-part (Grin. PAGE OF