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PERMITTEE NAME/ADDRESSpwtMfrf-lWryNw?Le sti nl/D(f,,) <br />NAME <br />ADDRESS <br />• UO: i4.1? <br />FACILITY :S AD CC <br />LocATxxr PnLiSnv? CL <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPOESI OMB No 2040-0004 <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER [0. MGE NL*ABER ) <br />11 E: <br />MONITORING PERIOD = V E h <br />YEAR MO DAY YEAR MO DAY <br />1 FROM TO r.' <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUNCY <br />OF <br />SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PER <br />T <br /> MI <br />REQUIREMENT • 4 :: ; u L r 11 <br /> <br /> <br />r SAMPLE <br />MEASUREMENT <br /> <br /> <br />L PERMIT <br />REQUIREMENT <br />' 1 ;; h C E/ F <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PER <br />I <br /> M <br />T <br />REQUIREMENT a.. r h c <br /> 4 <br /> SAMPLE <br />M <br />ASUR <br /> E <br />EMENT <br /> PERMIT <br /> <br />REQUIREMENT .. - , <br /> y w <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />R 1 J. c Q h <br /> EQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT I. Y V ! :? U A <br /> <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER ' "^"' " " p`"•'r " ?•" tbai Uti dorvmcm and all /IlKhm entf were <br /> Prepared under my dlrerllon or wpe rvisim In atcoed <br />nse wllh • t <br />r TELEPHONE DAT <br /> <br />a <br />sys <br />* <br />m deslgned <br />In a "'her <br />uaMned <br />er <br />l <br />h E <br /> q <br />P <br />sonne <br />Properly gat <br />er and tr afualt the Infrrrmatlon <br /> submllted. Based on my Inquiry of the person or per em, who manage the 3nttm, <br /> or thoat persons directly reponsible for gathering the Infornullon, the Information <br />wbmilted ke <br />to the best of m <br />knowl <br />d <br />d <br /> . <br />y <br />e <br />gt an <br />belef, type, .,curare, and rnmpkte. <br />1 ¦m aware that there are %I <br />nlntinl <br />en <br />lties f <br />b <br />i <br />i <br /> g <br />P <br />a <br />or su <br />m <br />tt <br />ng raker Informaton, SIGNATURE OF PRINCIPAL EXECUTTW <br />TYPED OR PRINTED InckxHni the pmelblllty of nm and Imprisonment ror knowing Aolatlorn OFFICER OR AUTHORIZED AGENT A AEA NUMElER <br />CODE YEAR MO DAY <br />r•nkAkAFNTC Afun FYPI ANATION OF ANY Vlnl ATInNe ro.r_._...._ _r ?N?wA??-.? •___r <br />?•n•t • _ f(.).. l T? ?. 1.I'I r. l i . t.. l,V (; L' L ?, <br />L r <br />EPA Form 3320-1 (Rev 3;99) Previous editions may be used <br />This is a 4-part form. PAGE OF