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PERMITTEE NAME/ADDRESSpwed,&F&-OIYNmw•rLorwl•wl(D(#Wwo) <br />NAME <br />ADDRESS } <br />vUX 14ju <br />LISAD1 CO <br />LOFACS0.f)O . if)51DL NORTH E SOUTH MIN <br />-i3 kALISADE CG <br />T -() N T- if T n RL U U <br />Form Approved <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM /INPOES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (OMR) <br />Lo., N j <br />PERMIT NUMBER k--C.AAM NUMBER Ii A L r E <br />MONITORING PERIOD ' • D 9 IC C C L C : . . ° E C b i V E F <br />-j YEAR MO DAY YEAR MO DAY <br />I FROM TO <br />NOTE: Read Instnlctlona bafo.acm;l*nlatino this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOLI NCY SAMPLE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> <br />r.. •- SAMPLE <br /> <br />r. . MEASUREMENT <br /> PERMIT <br />6 4 <br /> REQUIREMENT <br />. <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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I <br />"^'ry, ° " prna ty, c (law that lhh ment nd:11.11-Itmcnts "ere <br />TELEPHONE <br />DA <br /> nPared under my, dimellon or su Pennon In accordnn with a System designed <br />P TE <br /> <br />-+.-• to more that qu.Oned personnel property gather and evaluate the Information <br />r - whmilted. !awed on me Inquiry of the Person or prnonr who manage the arftem, <br /> or those Persms directly, mpon0ble for g.1h,rtng the Information, the inrorm•tlon - •' -; / <br />. submitted ht to the bat or my, knowiedge and beMef. Ime. arrote. and complete.. J / <br /> I sm ¦won that then on slpdflearlt penolda for submllting false Informatim SIGNATURE OF PRINCNAL EXECUTIVE - <br />TYPED OR PRINTED Inchrding Our podbully of line and Imprisonment for knowing eblotlona OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br /> ODE <br />C <br />VVInI?ILr?IV ?,•v r?r ?r?...?.. ?.. ?_ ___ _.??.... ?..- , ..r .r ?rrw? ?.. ....v..r rr?rrrr rr?r w/ <br />• i ..F .. ,c11;{?. i?a L1 • ?yL`r lL??h f (i:. _? 1f., F('„r`H ( Y C F <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. This is 3 4-parl fonn. PAGE OF <br />c