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PERMITTEE NAME/ADDRESS(7..6&i.rwyN..?L. efrew/(Do",) <br />NAME <br />ADDRESS <br />FACILITY L I S A U E cc <br />HUSIVE hOF{'tH L SOUTH MJ <br />LOCATION AR PAL13AUt Ct <br />L'S Inu t vi S.r,s r u .. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT ID RI <br />PERMIT NUMBER DISCHARGE NUMBEIR <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM To <br />Form Approved. <br />OMB No 2040-0004 <br />(such cwt <br />F - PlbAL <br />PUh? 1 TIC C( LC'r.i;C RIVEI <br />unrc• o__w t.,_.......t.,.._ 16.e--- ---_t_.t. , elvt. 1...... <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. VI NCY <br />FREG SAMPLE <br /> O <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> <br />?? SAMPLE <br />i <br /> MEASUREMENT <br />_ PERMIT _ t Y <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIR <br />ME <br />T <br /> E <br />N <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' nrt" y P`"•'y ° law thet this &,r meal and all Itwh=. wen <br />PnP•red under my direction or su <br />Perefslon In .ccond.n n with . syatem dniLned <br />TELEPHONE <br />DATE <br /> to aware that qualified personnel Property gather and evaluate the Information <br />' .. - submitted. Based on my Inquiry of the person or perwas who manage the system, <br />t <br /> or <br />hose perm directly respomlble for gathering the Information, the Information <br />b _ <br />_ su <br />mitted b, to the belt of my knowledge and betler, trove. accoratr. and complete. <br /> I am aware that then an significant Penalties for submitting rater inrormstion. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Including the podblgty o( new and Imprisonment for knowing .iolauorn OFFICER OR AUTHORIZED AGENT A A NUMBER <br />CODE YEAR MO DAY <br />:. s r,:?t:?t r.. .:C;IPw tail 1T C(_i_U?eS? S l:?T ETC EIE?r? C. F6CCF <br />EPA Form 3320-1 (Rev. 3799) Previous editions may be used. This is a 4-part form. PAGE OF