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PERMITTEE NAME/ADDRESS(7-&*F&,AfyNr.rL«ati wl(Dtfe ,) <br />NAME <br />ADDRESS <br />DUa 14 JU <br />FACILITY <br />LOCATION ?IGc hJ:,1n L Z, )UT h: 14iNE.G <br />PALISALt. Cu bib. <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESI OMB No. 2040.0004 <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER ascHARGE NUMBER y <br />MONITORING PERIOD L <br />YEAR MO DAY YEAR MO DAY <br />FROM TO `x7 <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. NCY <br />FRE° SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ' •' , • _ .T d <br /> SAMPLE <br />i <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />L <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT t :;. (, tc e a t L r' ': V C b i I f . r s <br /> <br />. ; . ., i SAMPLE <br /> MEASUREMENT <br /> PERMIT r ; U : i. t i7 h T *, a r, ?1 •? ,.: F r? i r1 <br /> REQUIREMENT - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />r. r. i T Y <br />. <br />; ,I ra : <br />?. x. • .:: ; <br />E r. L " <br />M <br /> REQUIREMENT <br /> N <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE -- <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I nriely under penalty ° law that this <br />document and all ¦tt.chrewtu were <br />ared <br />re <br />d <br />i <br />TELEPHONE <br />D <br /> <br />p <br />P <br />un <br />er my direct <br />on or supervision In accord.nce with ¦ system designed ATE <br /> to assure that qualified Personnel PfDPQA7 gather and evaluate the Infrwntallon <br /> mbmitted. Based on my Inquiry of the Person or persons who manate the system, <br />- or those persons dlrectlr a porndbk for gathering the Informatlo., the Inforvtillo. <br />sub <br />itird K to th <br />b <br />t <br />f <br />k <br />. .. m <br />e <br />es <br />o <br />my <br />nowledge and beMer, true, ar-mle, and complete. <br />1 ¦m aware that then: are slgnlfica.t penalties for submittin <br />fals <br />I <br />ro <br />tl <br />SIGNATURE <br />F P <br />I <br />I <br /> <br />I <br />. <br />TYPED OR PRINTED <br />ure aen of aal ATtn?t nC AMV Vint g <br />e <br />n <br />rma <br />on. <br />Including the po.dbill tr of Ilse and ImprW.ment for knowing Helallorrs <br />ATlrsue O <br />R <br />NC <br />PAL EXECUTNE <br />OFFN ER OR AUTHORIZED AGENT CAREA <br />ODE NUMBER YEAR MO DAY <br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used <br />This is a 4-parl.form. PAGE OF