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PERMITTEE NAME/ADDRESS (74-" irOlYN..?L-.tton (JD(Qbnn/) <br />NAME <br />ADDRESS _ <br />DOA 14JV <br />?AU6 CL <br />FACILITY j i V G is U !, i s r, `. t 'J 1 Cl 9 J <br />LOCATION P A L <br />--jUN i. K. i 1:,, r n _ V _ U_ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTDA NPDESI <br />DISCHARGE MONITORING REPORT fD R! <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />01' ,. FROM TO , <br />Form Approved <br />OMB No 2040-0004 <br />f - FIr/AL <br />POND lv ZC CC-hi <br />NOTF• Ra.A Irsetntmfr h.tnra rmmnlatinn this fnrm <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREG <br />LI NCY SAMPLE <br /> O - <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i 1. 114 N, AK i:1 L <br /> <br />/ SAMPLE <br /> MEASUREMENT <br /> PERMIT e _ . . O ` C z <br />V r <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT tiayitQ uGi l ?? C N T 1 N <br /> REQUIREMENT <br />i ' <br />i• 1 <br /> SAMPLE <br /> MEASUREMENT <br /> <br />L' PERMIT r. ! t? ?. S r l a . a :•.. x- r. '..^. 4 L' : c <br /> REQUIREMENT i v <br />a A •v ? f A L Y <br /> . <br /> SAMPLE <br /> MEASUREMENT <br />i PERMIT it L h G R 1' <br />L <br />tr ` <br />- REQUIREMENT ss r.ax - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER i Cen'ly ° r pen. ty bw that thb document and all altachmrnts veer <br />e <br />d TELEPHONE <br /> <br />pr <br />pare <br />under my di-tbn or suprrvllon In accordance with a system designed DATE <br /> to arture the( qualified personnel properly gather and evaluate the Inrormallon <br />submitted. Beard on my inquiry or the person or <br />ersom wh <br />n <br />e th <br /> p <br />o " <br />ot <br />e fntem, <br />or those penero directly resporMbk for tethering the wbmnatlon, the Inrornrtlon <br />b <br />itt <br />d b <br />th <br />t <br />b <br />r - - , <br /> su <br />m <br />e <br />, to <br />e <br />es <br />o <br />my knowledge and belief, true, accursle, and complete. <br /> 1 em ¦.am that there are slgnlficsat penalna roe oubmltnng raise Information, SIGNATURE OF PRINCWAL EXECUTIVE '- <br />TYPED OR PRINTED <br />Ilal AG •krV \/.- Including the possibility of flow and Imprisonment for knowing vldatiom <br />aTlrl.rw OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />vvrerr?ra.r.r? ?r.v ??• .,........?.. ?. .... ..??.... ?.. r•r.r .. wr. a.w w. .rrwa.r rr.rwrr a.a /rwl ./ <br />. PhECIF. ?Ych1 Ct <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This IS a 3-part form.