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PERMITTEE NAME/ADDRESS (Y-e&& FecOry Afa-?Locorron ((D(Q,-r) <br />NAME <br />ADDRESS , <br />• :) U S 1 Ls ? t) <br />.;her c? <br />FACILITY <br />mil.::. :+untn o SCJ:'t-m "il <br />LOCATION <br />ALtsAUM Cl; <br />50h L . Is is r ii. d _ G _ <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved <br />OMs No 2040-0004 <br />(5ULti LO) <br />r' - fIhAl <br />FLnD ;i IC L L A L CF <br />NOTE: Read Irvatructions before t'ompiatlng this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• UENCr <br />FREO SAMPLE <br /> O <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAtrsfs TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />• v <br />i i <br />! 5 i i U <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ti n t 1 L r.: / _ <br /> REQUIREMENT <br /> r" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT T <br /> REQUIREMENT <br /> C. i <br />i •, ?vdL? <br />t SAMPLE <br /> MEASUREMENT <br />i PERMIT R FU%'T .?,rU ' <br /> REQUIREMENT <br />- <br /> r DAILY <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :?cfrURl' .. ,:? ;, ;• cKiy ij Lrm <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTNE OFFICER t Mlay'.ndff penalty ° low that Ihh document and all atlachments were <br />TELEPHONE <br />DATE <br />prepared under my direction or wprr.llon in accordance with . system deslgmmed <br /> to mare that qualified personnel property gather and tyafuale the Information <br /> submitted. ll e d on my inquiry of the person or persona who ma ,sge the system. . <br /> or those penom directly mpomulble For gathering the Inrormation, the Information , <br /> submitted b, to the best or my knowledge and belief, true, ae vratt, and complete. - <br />' <br /> 1 am .were that there are zItWflcant pemattles For submitting false Inrornetfon. SIGNATURE OF PRINCIPAL EXECUTIVE - <br />-- <br />TYPED OR PRINTED Including the possibility or Fine and Imprisonment for knowing rlolatlons OFFICER OR AUTHORIZED AGENT A <br />? <br />NUMBER YEAR MO DAY <br /> CODE <br />AIV V CArL^FVP% I mere yr nn m e mvU m n?rizt, IrFterrrrn Cl on affacirimIn FJ n•rel <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is a 4-Part form. PAGE OF