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PERMITTEE NAME/ADDRESS pwolotia WgN??lee.etew l/DIQGw.r) <br />NAME <br />ADDRESS <br />• aOA 14JU <br />FACILITY S A D L CL <br />LOCATION 61Dt NURTH 6 SCUTh M3 <br />PALIZALi: cc <br />:nu t " VIf,nrfi, v_u <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESI OMB No. 2040-DD04 <br />DISCHARGE MONITORING REPORT (DMR/ <br />PERMIT NUMBER INUMBER _ r 11% AL <br />C. E II <br />MONITORING PERIOD 2 IC CC LG R A LC R I V E B <br />YEAR MO DAY YEAR MO DAY <br />1 ti , FROM TO <br />? <br />NOTE: Read Irmtructlone before q Iplating this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, fREOUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAtysts TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> •7> 0j Itg. <br /> <br />' SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />t" <br /> REQUIREMENT <br /> :r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> <br />" SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT p ti y '_ / u J C h R/ c r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />: ° »L t+^ <br />:t F c '? :? i <br />i % <br />v <br />C t, <br />I. <br />1 SAMPLE <br />' MEASUREMENT <br />?.. <br />1"MLIrT <br />ixirA <br /> <br />` PERMIT <br />l <br />I T .? '[ n <br /> REQUIREMENT <br /> <br /> SAMPLE <br />' MEASUREMENT <br /> <br />PERMIT hFpL t'GhT <br />REQUIREMENT r_ <br />, Y <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertrty " v pen"' ° Is- oral 1hH dornment and as aftacnments were <br />TELEPHONE <br />d <br />i <br />t <br />H <br />DATE <br />Prepare <br />under my d <br />rect <br />on or suprr <br />attm In accordance with .system designed <br />to asure that qualified personnel protwrly t.ther and evaluate IM Inrormailon <br />submitted. Based on my inquiry of the person or persom who mana <br />e the s <br />stem <br />g <br />y <br />, <br />at those <br />ereem directl <br />res <br />ordble f <br />i <br />th <br />th <br />I <br />f <br />p <br />y <br />p <br />er <br />ng <br />or la <br />e <br />n <br />ormation, the Information <br />d <br />" <br />submitte <br />Is. to the best or my It w <br />to and belief. irae, amumte. and compote. <br />- I ¦m aware that there are sI rrlnont pen.itles for submitting false Informaion <br />SIGNATURE OF PRINCIPAL EXEiCU WT <br />PRINTED . <br />Indudln <br />the <br />adblllt <br />of fine and im <br />ris <br />f <br />k AREA <br />TYPED OR t <br />po <br />y <br />p <br />onment <br />or <br />nowing vloiatlorn OFFICER OR AUTHORIZED AGENT ODE NUMBER <br />C YEAR MO DAY <br />t.UMrvtt:n t a rrnv cnr <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. r This is a 4-part,form. PAGE OF <br />. .-1t 1-.