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PERMITTEE NAME/ADDRESS (7na"Fw**N,@x*?Laear/ow 1/D(dbwq). <br />NAME <br />ADDRESS <br />J. SADE Ct <br />FACILITY L) 5IDF_ 1-40F` SOUTH M: <br />LOCATION PAL i SADt. C( <br />1)NiL. K I DDER. V, P. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDES) <br />DISCHARGE MONITORING REPORT (O R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY I YEAR MO DA <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />- <br />- REQUIREMENT r <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> <br />REQUIREMENT , I?t <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT - <br /> <br /> <br />4 <br />REQUIREMENT l \I? I IN r, <br /> <br />0 SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />LN ' PERMIT <br />REQUIREMENT <br />QR T R AVG, <br />x <br />•', R TR MAX <br /> SAMPLE <br /> MEASUREMENT <br /> - <br />PERMIT <br />REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t ",Illy under Pen. ty o low that UN document and all atlachmenla wen <br /> <br />/? <br />TELEPHONE <br />DATE <br />prepared under me direction or fuperrlfon in amxdanue with . fyelem eeslarwd <br />l <br />-? n to am" that qualified personnel propeAY gather and eraiuate the Infl rwsllon <br />?"' <br />_ <br />tublIfIlted. Based on m7 Inquiry of the person"penoes who manage IM fnlem, ?/I r r _J (L_ I "?-' "1 <br />o <br />th <br />tl <br />m <br />ordble f <br />r <br />o <br />s di <br />the <br />in <br />I <br />f <br />th <br />th <br />ti <br />f <br />r <br />ose Pe <br />s <br />n <br />rec <br />y <br />it <br />or ga <br />g <br />e <br />n <br />r <br />orma <br />on, <br />e In <br />or aillnn <br />_ <br />I <br />\ <br />^• <br />ltled is <br />th <br />best of m <br />tno.kd <br />C <br />wb <br />t <br />and b <br />B <br />f <br />t <br />t <br />d <br />T <br />" <br />:: ( <br />t <br />y <br />' <br />m <br />, <br />o <br />e <br />ge <br />e <br />e <br />. <br />rue, amnn <br />e. an <br />rompku. <br />I am aware thal the" a" dtnlfleint PMalnes fee submittin <br />SIGNATURE Of PRINCIPAL EXECUTIVE <br />War Inf-merfon <br />TYPED OR PRINTED g <br />• <br />Including the pondbluty a<nne and imprisonment for knowing •lolatlom OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS (Reference Sf effsehmenfS hers/ <br />EPA Form 3320-1 (Rev 3198) Previous editions may be used. <br />IDED SOLIDS (TSS). TOTAL IRON ANC/I <br />00076/t.,y