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PERMITTEE NAME/ADDRESSpa-&rF rWgN..rL«.ttow((DOWwu) <br />NAME <br />r <br />ADDRESS L <br />- bU:r 14 .l ti <br />A LIE cc b1529 <br />FACILITY <br />-510L ?C.t.T:l SGUTH 1111NE;S <br />LOCATION PALI:?A UE CG b1:?11 <br />• :flu 1. it T 1`, r. w r V n <br />Form Approved <br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM //NPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT IDMR/ <br />.?t1 L4) <br />PERMIT NUMBER DISCHMOE NUMBER <br />- FINAL !lESA <br />MONITORING PERIOD -, N O b TC CCA L C b E E e <br />FROM YEAR MO DAY TO [YEAR MO DAY <br />NOTE: Reed Instructions befori co plating this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FRIOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br />• PERMIT <br />• „ <br />L <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />/ J <br />- / <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ..< re 1' r E C n 'I _ / <br /> REQUIREMENT <br /> v M <br /> <br />t ?1 SAMPLE <br /> MEASUREMENT <br />• I <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />L PERMIT <br /> REQUIREMENT <br /> t _ <br />i SAMPLE <br /> MEASUREMENT <br />` PERMIT i1GEUt .' GFI:r <br />KL} <br />i?,? •i <br /> <br />v REQUIREMENT <br /> <br />1 ?J SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> <br />REQUIREMENT PC <br />; <br /> <br />' <br />t (: r 3 <br /> r a A <br />v , n i1 A A <br /> <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER 1 vervly under penalty o law that thh document and .11 attachments were <br />TELEPHONE <br />DATE <br /> prepared under my direction or mper+b/on In ereord.nre with . system designed <br /> to sere that quslined pereonnet property gather and evaluate the Infortsullon j <br /> tatbmllted. Bawd on my Inquiry *(the person or person who manage the system, <br />' <br />' or those persau directly respondble for gathering the I"fam ttlew, the Inrormallon • <br />/- ' . - <br />-" <br /> <br />- , _ - su <br />bmitted b , to the best or my knowledge and better, true, accurate, and complete. <br /> <br />1 .m .ware that Ihera are dgNlkant penalties for aubmliting robe Inrormatioet <br /> <br /> <br />IGNATURE OF PRINCWAL EXECUTIVE <br /> <br /> <br />- <br />? <br />( <br />_ / <br />- <br /> , <br />I <br />t <br />d A WA <br />TYPED OR PRINTED nc <br />u <br />ing the poadbittly of flae and Imprisonment roe knowing Ootatloem OFFICER OR AUTHORIZED AGENT Coo NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Ur ANT vwl.A I IUNS friersronca on orracnmenrs hard <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This IS a 4-pan rorm. PAGE OF