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PERMITTEE NAME)ADDRESSQa.6&FwWryNo.WLecwimtfD(A-1) <br />NAME <br />ADDRESS ! <br />. ? • :? t 3J1 14 .i'J <br />FACILITY 1 U L' !. ?, fi 1 N 5 L IJ 7 t2 M i <br />LOCATION a 4 I A L <br />KTi.rl_ V_t _ <br />NATIONAL POLLUTANT DISCHARGE 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 />OMB No 2040-0004 <br />a,r sr. <br />C Ci i I C", <br />N(1TF• R..A In. tn,.-rl.,.?.. h.(.v. .........'.tines fhl• Inrm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. UFNCY <br />FREQ SAMPLE <br /> O <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYsls TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ; ± I -- <br /> REQUIREMENT <br /> L <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i ' is L ! 'I, <br /> REQUIREMENT <br /> SAMPLE ; <br /> MEASUREMENT <br /> PERMIT <br />M <br />T r 4. A z :. <br /> REQUIRE <br />EN L :± 1 1 ! i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L / <br /> REQUIREMENT A v a I L r k t :, <br /> SAMPLE { <br /> MEASUREMENT <br /> PERMIT r, = •' a , <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />1 PERMIT U^ i EFUrT <br />77 <br /> REQUIREMENT L Y :. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER ' " to pen' by ° 1" that this d°runar.I and .11 tlwh-nb..eR TELEPHONE DAT <br /> <br />prepared under my dlrecllon or mperrhlon In arrord- with a system designed E <br /> to amure that quatined personnel properly gather and evaluate the Informatlon <br />submitted <br />Boa <br />d <br />n m <br />In <br />uir <br />of th <br /> y <br />. <br />r <br />o <br />q <br />y <br />e person or persons who manage the system, <br />or M <br />er <br />o <br />di <br />tl <br />ibl <br />f <br /> oor p <br />s <br />ns <br />rec <br />y respons <br />e <br />or gathering the Information, the Information <br />b <br />it <br />d h <br />h <br />k <br /> su <br />m <br />te <br />, to t <br />e best of my <br />nowledge and belief. Im.. acrt mie, and complete. <br /> I am aware that there are sigNHunt penalties for submitting rate Information. SIGNATURE OF PRINCWAL EXECUTIVE -- <br />TYPED OR PRINTED Including the possibility or line and Imp.1 ment For knowing vlol.llorm OFFICER OR AUTHORIZED AGENT COREA DE NUMBER YEAR MO DAY <br />. L 1 Ct, a _ • [4.1'r, t t !'?, iF a Ir L L.L.CUF< 1;?.J C? iC G FLC 1 <br />a ?, t r h (, T <br />EPA Form 3320-1 (Rev. 3/99) Previous ediborn may be used. TIUS IS a L Pert Form. PAGE OF