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PERMITTEE NAME/ADDRESS On" FedbryNanua/Leeanon l/ Ors-r) <br />NAME r.i q <br />J 1J tJ s:i ?..? Ld IS. 1J ?, 4 ? ii ?: ? ?? d t q^ <br />,h ?J C • <br />ADDRESS <br />t?:51 dpi; ?()!''?l SaG`d b3 <br />YI P 1S w <br />P.O. buoi 14jo <br />ALIL: AI) -% CC 61526 <br />FACILITY <br />Rtor1D5IDt:r 'WORTH <br />6 SCUTfr: e:iki <br />toa <br />. <br />LOCATION <br />,!. Ass PALIZADg <br />Co di5, 6 <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT`NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO . DAY <br />FROM O [l O% t) To O R '3_11 1 <br />Form Approved. <br />OMB No. 2040-0004 <br />I -b 011 <br />PQ V i+ SL li1'67 , 6;I NOTE:) Read nstru one 9 ors,oo pRl Isting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> <br />s. SAMPLE <br /> MEASUREMENT <br />t) 4 U U 1 j 0 PERMIT <br />REQUIREMENT <br /> <br /> <br />UALID5e TOTAL SAMPLE <br />- <br /> MEASUREMENT <br /> <br /> <br />?b 3gk! PERMIT` <br /> REQUIREMENTS <br />g?r <br />SOLIDS, SETTL?;ABL,L SAMPLE 4 } <br /> MEASUREMENT <br />U tid 04.E 1 U PERMIT <br />x C r <br /> REQUIREMENT <br />t 'R`;:« n r <br />Ri30, dflTi;L SAMPLE <br /> MEASUREMENT <br /> <br />J)IU <br />Ur rs L co PERMIT <br /> REQUIREMENT <br />nr;? ht e- P, T f!a i <br />U I SAMPLE <br />d S? A <br /> MEASUREMENT <br /> <br />U <br />.3 ? ? ? ?. 'PERMIT <br />REQUIREMENT <br />o ?i. tt,3? f r' G <br /> <br />FLU*;), IN CQUUI;IT OF SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT " <br />REQUIREMENT <br /> <br />?a 11 zl r . a In 1 <br />F IV 1. i <br /> <br />, <br /> <br />.A.«dTa; <br />hL+lSS t9tir <br />OIL <br />SAMPLE <br /> <br />.7 ? <br /> MEASUREMENT <br />V1J'UAL <br />E <br />PERMIT <br />64Ubb 1 0 U <br />REQUIREMENT <br />«+ <br />E PRINCIPAL EXECUTIVE OFFICER I Witty under penalty o law that thb document and all attachments were <br />NAME/TITI <br />TELEPHON <br />E <br />D <br />T <br />. <br />prepared under my direction or supervMon In accordance with a system designed ((( A E <br /> <br />. <br />8 <br />C to assure that quatined personnel property gather and evaluate the Information <br />an sullied <br />Based on m <br />In <br />uir <br />of the <br />erson or <br />ersons <br />h <br />h <br />, Y" <br />-1. YY . <br />y <br />q <br />p <br />p <br />y <br />w <br />o manage t <br />e system, <br />th <br />l <br />di <br />ibl <br />f <br />t <br /> or <br />ose persons <br />rect <br />y respons <br />e <br />or gathering the Information, the Information <br />C?l I <br /> submitted b, to the best of my knowledge and belief, true, accurate, and complete. <br /> 1 am aware of there are significant penalties for submitting tabs Information, SI Ai RE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Including the possibility of line and Imprisonment for knowing rlolaUoln OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />GUMMtNIb ANIJ <br />5s Iai?. a[ e bC'E k I ia'a'L' I. r;1 '?,?ICi i i3 ?x 1C ® ? I ECi a EvliiJT- GGCp) t ® SUBJEC'I '10 JJL.1?E,Y C CCF <br />SEL EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. T S is a 4-PBiIfgTlll. PAGE OF <br />00454/0