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PERMTTEE NAME/ADDRESS pwaYftFerWty Nw?L«slew (/D(Ola Sul <br />NAME <br />ADDRESS , . <br />LiUA 14 JU <br />.-SADL CO 815: <br />FACILITY ; jJL)h 1.UrtTit 6 SCUiti tiI L5 <br />LOCATION PALISP.CI; CG bit. <br />rnu art rr cr. sr n <br />Form APproved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION sYSTEm //IVPOESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMB EIt _ } I A L r Z.) II <br />MONITORING PERIOD +` L• 10 I c CCA L C F E-.N <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Reed Inetructlons beftx?ompletfnp We form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />Y <br /> 1>< ANAlrsls T <br />PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , U <br /> REQUIREMENT . <br />M + V <br /> <br />r SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT 3 E; LA <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT Chi111 <br /> REQUIREMENT - 1 <br />r <br /> SAMPLE h <br /> MEASUREMENT <br /> <br />1 PERMIT ?r(jrtl [L i:? .i, _cnLY l y 7n <br /> <br />,. REQUIREMENT <br />t <br />?. SAMPLE <br />U MEASUREMENT <br />L Y L <br />?. ,., <br />` PERMIT <br />E <br />IRE <br />ENT otAIG> t;trCr i riFFCb1 <br /> R <br />QU <br />M <br /> <br />V SAMPLE <br /> MEASUREMENT <br /> <br />- PERMIT it E <<::; -A r : ? L 1 i `: U <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER 1 mmly under penalty o law then this document and all ettachm <br />Prepared under my direction or mper.rron In eccordence with enU were <br />• system designed <br />TELEPHONE <br />DATE <br /> to alm," that quahned persennN P*awr+y tether and evaluate the inrormetion <br />b <br />llled <br />S <br />d <br />In <br />ui <br />r th <br />r <br />wh <br />th <br />? <br />i su <br />m <br />. <br />on my <br />q <br />ry o <br />e person o <br />penum <br />o menage <br />tate <br />e "em, . <br />? <br />- <br />- <br /> or than persons directly rnpoedble for gathering the Information, the Info -noon L t. t..•. •. - <br />.. -.f <br />:Ci. %t ?, / <br /> submitted * to the best of my knowledge and be*,r. true. aeewnte, and complete. <br />1 am aware that then are si <br />nificant <br />enalties For <br />bmittin <br />hav <br />Inf <br />tio <br />SIGNATURE OF PRINCIPAL EXECIITT/E <br /> g <br />P <br />su <br />g <br />e <br />orma <br />n, AREA <br />TYPED OR PRINTED Indetding the possibility of line and Imp Ism ment For knowing vidatlcm% OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION UP ArvT vtvLn I Iona rmorerence an errecnmenrs nerel <br />_ _ : h,?4Hh rRcCIF. cYE, LLCUIIS, SUBJECT TO EGHLEN CF FJiLCF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This: IS a 4-part form.