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PERMITTEE NAME'ADDRESS ilwlade F'acdiry• lda wEocatimi ijDifferenp <br />NAME <br />;ICI F?•1::h_??, ItJG. <br />ADDRESS I'JE <br />1 <br />FACIUTY <br />LOCATION <br />;'Q 51645 <br />M AwIAP??t:] <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <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 />RBLAN <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUAUTY OR CONCENTRATION NO fREUUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />a I MEASUREMENT V, S esA, <br /> <br /> PERMIT k <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <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 />NAME/TITLE PRINCIPAL EXECUTNE.OFFICER I certify under penalty of law that tht+document and all attachments were TELEPHONE DATE <br /> prepared under my direction or supen ision to accordance with a ry5tem designed <br /> <br />S?G%/ ` <br />!!//? J to assure that qualified permmnel properly gather and esaluate the information <br />rson or <br />stern <br />iry of the <br />rsons who mana <br />e the <br />t <br />d <br />B <br />d <br />b <br />i <br />- <br />? <br />- - <br />t/• on my inqu <br />pe <br />pe <br />g <br />y <br />. <br />su <br />t <br />e <br />. <br />ase <br />m <br />or throve persons directly responsible for gathering the inftmnanon. the information _ <br />"' <br />l- _ submitted is. to the best of my knowledge and Witt- true. accurate, and e.,mplete. <br /> <br />f <br />l J <br />SIGNATURE OF PRINCIPAL EXECUTIVE - - • :" ' .f ?. G.. e-, -f <br /> <br />rn n <br />i <br />a <br />se m;.mtauon <br />i aware that theft are significant <br />fen t <br />4 <br />f <br />k <br />OFFICER OR AUTHORIZED AGENT <br />AREA <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />TYPED Ofl PRINTED ow <br />o <br />mcl cludiug th.: possibrhrv of tine and and imprisonment <br />nowing an <br />an?n"• <br />or CODE <br />COMMENTS AND EXPLANATION OF ANY VIULAI IUNS (Hererence an anacnments nere) <br />EPA Form 3320-1 (Rev. 3,+99) Previous editions may be used. <br />- SEE I. A. 1', PG. 3. FOR RF <br />ICTIONS - I. C;. 7. , P,:?. 14. <br />This j3p 4, t j torn. PAGE OF