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PERMITTEE NAME/ADDRESS r7neirdr faeWerN?r.. Leca/ar (/DDQG.ewr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTUA fWDESJ For OMB No 2040-0004 <br />NAME DISCHARGE MONITORING REPORT (DMRI <br />ADDRESS <br />PERMIT NUMBER k-SI.-GE NuMeEA <br />T c <br />FACILITY - ?I-' MONITORING PERIOD <br />LOCATION 7t PALISADE FROM YEAR MO DAY TO YEAR MO DAY <br />-SON t_ i(f ?; f?t I '. NOTE: Reed Inetructione before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />1 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I nrtrn er pens tr o Iaw that thH document and.n attachments were TELEPHONE DATE <br />Prepared under my dlnctbn or auperelalon In accordance with • sfatem designed <br />- _ -, Io Mum that 9-1111ed personnel Proper tether and eer iuete the Infarmatlon <br />(the person or <br />Submitted <br />Bred on my Irr <br />ulr <br />ersoro who mana;e the t <br />reem <br />- <br />. <br />q <br />7 <br />p <br />r <br />. <br />or those persoro directly mpordbk roc gathering the Inrorwutl, the Informad- i <br />- <br />- , <br />- <br />Submlitrd b, to the bast o( my knowledge and be*rf. true, a ralr. and complete. <br />b-stri <br />SIGNATURE OF PRINCIPAL EXECUTWE <br />I <br />th <br />t th <br />lnc <br />t <br />lrl <br />f <br />rat <br />I <br />f <br />d <br /> am aware <br />en are <br />gn <br />an <br />pena <br />ea <br />or ru <br />ng <br />a <br />n <br />a <br />ormarlem. AREA <br />TYPED OR PRINTED Inc%Wlni the poedbin4 of nm and Imprisonment for knowing .lol¦Uo OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br />AL 730?3PFIVDED SO! T DS ! TSS? , TOTAL- : RSN qN)?!(?!L,1 <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used MS 15 8+4-part fOrRr. PAGE OF