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PERMIT-TEE NAME)ADDRESS ()tta&& trihryWom*?L c. it I/D(fwwv) <br />NAME <br />r <br />ADDRESS <br />. ,? bQA 143Q <br />FACILITY A 4 CL <br />nD51DE NORYE o SCUTh 15I <br />LOCATION n N P A L I S A L L cc <br />• . t s' rk Al T t. 7 tr h a .. <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />yi FROM TO Y <br />Form Approved. <br />OMB No. 2040-0004 <br />(SUER DO) <br />F - FIAAL 144 <br />FCOIL 1 TIC C:CLGi:A4C ?Xu: fI <br />It1ATP• 12-A f-- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION No. NCY <br />FREQ <br />U SAMPLE <br /> O <br />F <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT t. k T i r. <br /> REQUIREMENT <br /> S• <br /> SAMPLE <br /> MEASUREMENT <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMnE PRINCIPAL EXECUTIVE OFFICER I `emly -d,, pen. ty o I.» that this document and on attachments were <br />r <br />d <br />d <br />i TELEPHONE DA <br /> <br />p <br />epare <br />or <br />er my d <br />rsctlon - wPr-Won in accordance with . system designed TE <br />- - to cause that qu.Mned personnel properly gather and evaluate the Inrorrnalloo <br /> submitted. Bred on my Inquiry of the Person or person, who tnan.ge the system, <br /> or those persons directly respon,lble for gathering the Inlornwrion, the Informalion <br />b <br /> su <br />mitted Is. to the best army knawiefte and belief, true, accurate, and tomplate. <br /> I am .ware that there on slgninc.nl penalties for vabmitring tab* Informallon, SIGNATURE OF PRINCIPAL EXECUTIVE <br />- TYPED OR PRINTED <br />- -- -- - - -.. _. .... _.,... ,.? ..,., ...,.. lnchrding the posdblllly of nne and Imprisonment for knowing .lol.tlons <br />. ?....._ ._ OFFICER OR AUTHORIZED AGENT AREA NUNWR <br />CODE YEAR MO DAY <br />t,.vmmcn n a nnv ?nr vsrer.. •v.. ... .-... .... ?,-, ..v•e.r to w, av wr,car an, .rn.rcwnwnlJ n.rwt - <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This is a 4-part form. PAGE OF