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PERMITTEE NAME/ADDRESS(7m"F ihtyN wL ,wim1/D(#6wd) <br />NAME <br />ADDRESS w <br />. ei:. bux L4jv _ <br />; SADi ICU <br />FACILITY j1DG WORTh ?; 5CUTh MlI <br />LOCATION P A L l5 A DE C() <br />C,0N T_ WT11CGL V_n <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESI <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />d i FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />(5ubh L i+) <br />F - FINAL <br />P0DJ) d IC CCLCfiAtC :;1Y <br />KIrWTV- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />t <br /> MEASUREMENT <br /> <br />f PERMIT <br /> REQUIREMENT y c J <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 /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PER <br />I <br /> M <br />T <br /> REQUIREMENT <br /> <br />NAMEMnE PRINCIPAL EXECUTIVE OFFICER ' n"I y ° r Penalty ° low that u+h docnrnenl and all attachments were <br />R ared under m direction or su <br />P P ? peculators to acrnrd.nre with . system ddgned <br />TELEPHONE <br /> <br />DATE <br /> to name that ga@An d Perwnnet Properly gather and eealuale the Infornulksn <br />r 1 <br />- sobmilled. Based on my Inquiry of the person or persons who manage Ihe fratrm. <br /> or thou persow directly rnpor4dW foe gathering the Information, the info' lion <br />b <br />d I t \ c <br />•. <br />- <br />.. su <br />mitte <br />K to the best of me knowledge and behW. true, accursle, and complete. <br />16.0. are that then are slgtdfk.nt Penalties for wbmltNn <br />Inf <br />b <br />rr <br />tl <br />SIGNATURE .. -% ,, (_: <br />7 <br /> <br /> <br />TYPED OR PRINTED <br />--... .?..?_ ..... ....... .. r r.r auv vrr.r g <br />e <br />o <br />m <br />on, <br />IMuding the potaibilily of nor and Impelsonmenl for knowing Aolauotn <br />air...... ... .. .. OFFICER OR AUTHORIZED AGENT <br />AREA NUM <br />ETER <br />CODE <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />.Y..:e:.a E't7R hLIih'wAT?: L? :LYF,14dR ; -EC I?. eVEII CCCr'F5 SI?t?JEC: Ica E <br />t;i:Gf C. EfCCE <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 1 ` This is 4 4--pert form. PAGE OF