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PERMITTEE NAME/ADDRESS(7.c64F dkeyNa.?L«wi• I(D(06ewu) <br />NAME <br />ADDRESS <br />5OX 14JU <br />15AUL CC 0151 <br />FACILITY JjU[. ievhit: tr SC1uZh `IINF5 <br />LOCATION F A L I :) A U h C U d.L 5 1 <br />,c I ., e . T r. 11 i 1. u n <br />Form Approved <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM (INPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT WMRI <br />PERMIT NUMBER DISCHARGE NUMBER - F I N A L A k.5 A <br />MONITORING PERIOD -NU 11 IC CC A L C F E E K <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ? <br />NOTE: Re*d IntstrvctiofTis boforti completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FRE°UENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />i <br /> MEASUREMENT <br /> PERMIT k) • L t ti, <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />L t. i. <br />1 :• , i ... SAMPLE <br /> MEASUREMENT <br /> PERMIT L.?nr =: cttk. k'CF'I C <br />F J-' ti T REQUIREMENT y;L I L Y i' X " C {? ::' <br /> SAMPLE <br />t <br /> MEASUREMENT <br /> PERMIT _ " _ Yr7tF??`rr, >; 101A« 7 U'JO <br />t REQUIREMENT _ r n '? _ :.+ r 1 Y " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :+•?ts. ^ia'liHi' ?. . <br /> REQUIREMENT <br />! SAMPLE l !, 3) <br /> MEASUREMENT <br /> <br /> <br />:? PERMIT :/ [: i C ?.T <br /> <br />- <br />t_ n <br />U t i . REQUIREMENT * •. I L Y fI X <br /> SAMPLE - ) <br />;kiL MEASUREMENT <br />PERMIT CnY <br />REQUIREMENT P. A X <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I rert,ly under Penalty • Is. that this document and all attachments were TELEPHONE DATE <br />prepand under my direction or supervt!cm In accordance with a system designed <br />_ to assure that qualified personnel properly gather and evaluate the Information <br />submitted. Bred on my Inquiry of the person or persons who manage the system. <br />t <br />l <br />ibl <br />F <br />- ' <br />'L ; <br />' <br />( <br /> <br />- <br />. <br />I or those persons direct <br />y respons <br />or gathering the Informallaa, the Inforwatlon <br />- <br />.c_ <br />e <br />• <br />_ :- T <br />t <br />k <br />wled <br />b <br />d <br />th <br />b <br />f <br />d <br />f <br />o <br />my <br />no <br />.,_ su <br />mitte <br />Is. to <br />e <br />e <br />ge an <br />belie <br />, [rue, aeevrate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />th <br />t th <br />d <br />nif <br />ant <br />lti <br />itti <br />e <br />I <br />tl <br />I <br />r <br />b <br />r <br />r <br /> am swam <br />a <br />ere are <br />g <br />pecma <br />m <br />tr <br />on. <br />c <br />es <br />oe su <br />ng <br />a <br />n <br />orrna <br />TYPED OR PRINTED Inducting the passibility of fine and Imprhonmrni for knowing v olsllons OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIVLA I TUNS (Reference am •tracnmenrs nerel <br />,tgF;R PRECIP. EVThl OCCUnS, SUaJLCI 3C i-LELEN CF EFCCF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ` / This is a 4-pan form.