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PERMITTEE NAME/ADDRESS pm"F rwty N..rterrree (/DIQG.wuj <br />NAME <br />ADDRESS <br />tfUX 14 JU <br />?ISt?Di CO It <br />FACILITY D 51 D L li U hl ' h ti j C U T it M I N I <br />LOCATION nit; P A L I S A D E co t <br />.,L?iUls L. KIDUIR. Y.N. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDESI <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br />fA. I110FS <br />pUBTI Gw ) <br />F - FI bA L <br />POND 11 TC CCAL CbEF <br />NOTE: Read Imtructlorm befori'completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT - O Tt i Y = - r :. _ <br />L r i <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> <br />1 Anti, under Pena t] O N. that Uh d-unj and 0-N attarhr e,nt9 wtR <br />TELEPHONE <br />NAMElTTTLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />PRPared under my direction « -""Won In a ,d- with a system ddsned / <br />to mom" Thal qualfn'd Perwnnet Properly [alhee and eraluale the Information / <br />(th <br />ir <br />in <br />-J <br />f <br />b <br />ttt <br />B <br />n <br />d <br />d <br />1 <br />qu <br />y <br />u <br />m <br />e <br />. <br />ra <br />my <br />e Penes W Pera us, who manage the system. <br />o <br />I or those <br />j 'Yt l t ?- < < r y? <br />enem dinenl <br />ra <br />onsibir for <br />.1herlrt <br />the inf <br />tt <br />th <br />ti <br />I <br />f <br />l <br />p <br />y <br />p <br />g <br />E <br />orttta <br />oa. <br />e <br />n <br />orma <br />on <br />- submitted is <br />to the bat or my tnowted <br />e and bener <br />Ir <br />. <br />a <br />ml <br />nd <br />rn <br />t <br />t / <br />t <br />T <br />, <br />, <br />v <br />. <br />rru <br />r. a <br />P <br />e <br />e. <br />to <br />i .m aware that thrn .re tlrnlnc.nt Pen.ltte, rnr submltttnE W_ In ror 11- <br />SIGNATURE OF MIIMCI?AL EXECUTIVE <br />- <br /> . <br />t <br />TYPED OR PRINTED r <br />udtn9 the PoadbU1tr It nor and tmpcttonmrnt ror knowing .td.U.- OFFICER OR AUTHORIZED AGENT CE NUMWR A YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference MY attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This is a 4-part form. PAGE OF