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PERMITTEE NAMEIADDRESS(7.r&kfrWryN wWLoeatio (fDtarnlnr) <br />NAME <br />ADDRESS _ y <br />6UA j -4 J%, <br />b i Cu ii .A. <br />FACILITY r. (J U 'T tI it I is .. <br />LOCATION P A A Lu L C6 o 15 <br />it N t_ r 1 s. v ., <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT ID R/ <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 />C- CLCillLL tii%ci <br />NOTE: Raad Instructions before comnlatlnD this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br />Y <br />FREOUENC <br />SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />' <br />1 ; <br /> REQUIREMENT <br /> <br />v IAl -1 r' G <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />!.r <br /> REQUIREMENT <br /> <br />_ <br />h if L hl L I. <br />l .Y 1 L, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : z v l <br />r t t C is I <br />G T I t <br /> REQUIREMENT c . <br />I I SAMPLE <br /> MEASUREMENT <br /> PERMIT I. Y C. ft i E Ci l r a .. _. t a. K L Y !? <br /> REQUIREMENT <br />'' <br />y i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT aLiGhi' icr..t ?'1?Ck <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER ' fe^"' " t1 pe"' fly *(law that Ihh documenl and all allach, U.- TELEPHONE DATE <br />prepared under my directbn a mp""llon In accordance with • rysltm designed <br /> <br />- to a m that quallritd personnel property gather and e-Wale the Information <br /> r"bmilled. Bawd on my i"ulry of the prraon or peeaoeu who manage the system, <br /> or (hoar perstma directly resporeibM for gathering the Information, the Information <br /> submitted Is. to the best of my knowiedge and be*el. Ime, a mle, and complete. <br /> I am aware that there am significant penalties for submllting raise Information 91ONATURE OF PAINCMAL EXECUTIVE '-' <br /> <br />TYPED OR PRINTED . <br />Including the poadbillty of Ilne and IrnprUunment for knowing .lolauom <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />PAY <br />VVmMGre c J nrev ?i.r vs.. c....,.. ... ..... .._?....?.. r .... ......................... .....r <br />r V [ t) . v e C _ _ .. • [. 1, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. TILS IS 8 4-Pan focal. PAGE OF