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PERMITTEE NAME/ADDRESS (Inrlhir faavlryNasa/Larrlon l/D(Qli.wa) <br />NAME <br />ADDRESS <br />. bUX 14JU <br />."..)A DE cc <br />FACILITY <br />SIDE NORTH E SUUTh M1 <br />LOCATION <br />PALISADE (:U <br />VIW I' _ if T nA L L u u <br /> Form Approved. <br />NATIONAL POLLUTANT OISCHAAGE ELIMINATION SYSTEM NPOES) OMB No 2040-0004 <br />DISCHARGE MONITORING REPORT (D H/ <br /> i n <br />PERMIT NUMBER DISCHARGE NUMBER J <br /> F INAL !!Ey! <br />MONITORING PERIOD 1-0 1 I c cc 1 0 H A L c FIVE b <br />L., YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> NOTE: Reed Instruction s b4i1forixt Isting 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 />- <br />= t T l <br /> REQUIREMENT <br /> w M i <br /> <br />r.l SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br />y SAMPLE <br /> MEASUREMENT <br /> PERMIT _ !» t 1 b C / : n r <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />c, <br /> PERMIT _ rt! ?K+•tv r <br />l UU J <br />', ` `' / <br /> REQUIREMENT <br /> _V <br /> SAMPLE <br />( 1 <br /> MEASUREMENT <br /> <br />v ` PERMIT <br />' <br />?'ri3c*;t' <br />Z I D <br />c t! _: <br /> REQUIREMENT -V <br /> <br />r SAMPLE <br />I ' <br /> MEASUREMENT <br /> <br /> <br />.JJ 1 PERMIT <br /> <br />REQUIREMENT <br />.. YLi <br />I.?Il1 <br />- <br />..•_. <br />h f <br />` <br />1?.. <br /> <br /> <br />`` r t SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT C c _ <br />REQUIREMENT ` <br />t: <br />NAMEmnE PRINCIPAL EXECUTIVE OFFICER 1 Cent) under Pen' Fly o Ia. that thh document and alt attachments were <br />TELEPHONE <br />DATE <br />prepared under m) dlrxtbn or fuprr.laton In accordance with • system dalgned <br /> <br />j - to care that quaMned personnel properly gather and errJusle the Information <br />fubmltted. 6asad on m) Inquiry of the person or persoss who manage the system. <br />1 h or those persons dirvvly resportdble for gatherin <br />the Inform <br />ti <br />the Inf <br />ti <br /> g <br />a <br />on, <br />orma <br />on _ <br /> submitted Is, to the beef of my knowiWire and belief. true, accurate. and compielt. <br />1 am sane that There are dgndnum penalty for submltnng raise information. <br />EIONATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Including the poslbtllte of nne and Imprisonment nor knowing Ociatlont OFFICER OR A VTHORIZED AGENT COA NUMBER YEAR MO DAY <br />%.VMMCII 10 AMA cnr <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This IS a 4-part fOfin-