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PERMITTEE NAME/AODRESSpnebrrArwryN.l.?Lerrton(/pfpi,e.,,q <br />NAME <br />ADDRESS <br />bvk 14 ,jU <br />FACILITY SAUE CL <br />a 1 Li L n rl Ill I <br />LOCATION <br />FAL15:1';c CL <br />r:C T / 'r r - L _ Ir <br />NATIONAL. POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPOES/ <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DISCHARGE NU -II%F <br />MONITORING PERIOD <br />t.?. YEAR MO DAY YEAR MO DAY <br />O y FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />- f'i;ld1 <br />t+J :C C?'iCFACC t <br />NOTE' Read irvtnirtinn. h.fnr. rnrnnl.tinn this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FAE OfNCY SAMPLE <br /> 1>< <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />.. M <br /> SAMPLE <br />MEASUR <br />M <br />T <br /> E <br />EN <br /> PERMIT <br />REQUIREMENT <br />? ? - ` / <br />•' • <br /> 1 T _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />: / <br />b` <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />w - <br />(:. <br />r <br /> M <br /> <br />' SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT Evis' - <br />' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> I <br /> PERM <br />T <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I mmly er penalty .(law aim th <br />prepared under my di-rtion or supe h do"mrnl and all .u?hmenu were <br />MSlon In asrord.nrt with ¦ s <br />stem desi <br />n <br />d TELEPHONE DATE <br /> y <br />g <br />e <br />h <br /> to Bosom t <br />at quallned personnel property gather and evaluate the Inrornulion <br /> submitted. Stand on my Inquiry o(!he Perms a persons who manage the system, <br />• or those persons directly responsible rot, gathering the loformallon, the Information <br />ub <br />itt <br />th <br />d H <br />b <br /> m <br />s <br />e <br />. to <br />e <br />est of my knowledte and be lef, In te, atmumit. and c pkle. <br />I am aw.re that there are sigNnrsni penal0a for <br />bmitti <br />fat <br />I <br />f <br />SIGN <br />TUR <br />O <br />RIN <br /> su <br />ng <br />e <br />ormation, <br />n A <br />F P <br />E <br />CIPAL EXECUTIVE - <br /> <br />TYPED OR PRINTED <br />Including the possibility or not and Imprisonment for kno.ing Aoiauan. <br />OFFICER OR AUTHORIZED AGENT fA <br />NUMBER <br />"A <br />YEAR <br />MO <br />DAY <br />....a •a •r.t1•n a..t? tuna aat. T'-al nC ALIV iflr%l ATlnatr rea_d______ _u CODE <br />n F t <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used TIUS IS a 4-part form PAGE OF