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PERMITTEE NAME/ADDRESSpwaM4feey6ryNw?L wimt/D(&-i) <br />NAME <br />ADDRESS <br />00;k 14JU <br />-16 -15ADr. <br />CC <br />FACILITY J 1 <br />•`.SilJ E wtU N•L h 6 v Li U _ ?t• 111 <br />LOCATION . !: r A L I A D L D L CL' <br />! tifilu i ll ti <br />NATIONAL POLLUTANT OISCHARGE EUMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D RI <br />PERMIT NUMBER DISCHARGE NLWJIM <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />L r FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />F <br />E+ L h <br />NOTE: Read kw1ructlone before cornptatinp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> [>< OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT • <br /> REQUIREMENT <br />r <br />R <br />, <br />, , <br />. <br /> 1 <br />+ y <br />y <br /> <br />' SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />(` / <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />j j PERMIT t t , ;>+: rV t+ . <br />a E Y C 111 <br /> <br />:/ <br /> <br />^? F <br /> REQUIREMENT <br />:el L)A11 C '+Tr <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L E <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT rv.. :?E: <br /> REQUIREMENT <br />y <br />f <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />v L <br />REQUIREMENT <br />i <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I -1.8y ° er pens ty o law that this document end .n .uarhmente were <br />TELEPHONE <br />DATE <br />prepared under my direction or supen}>fon In accordance with . systtm designed <br />to assure that qualified personnel properly ga1Mr and evaluate the information <br />submitted. Based on my Inquiry of the person or pereons who manage the ! <br />'stem <br />, <br />, <br />th <br />tl <br />di <br />f <br />i <br />or <br />ose persom <br />rec <br />y respons <br />ble <br />or gathering the Informatloa• the Informatton <br />submitted K to the best of my knowledge and belief, true. accurate, and complete. <br />i am were that there an significant penalties for mbrrdtting ratty Inronttatlon• SIGNATURE OF PRINCWAL EXECUTIVE ,- <br />TYPED OR PRINTED InAuding the possibility of fine and Imprisonment for knowing violatlom OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />L:VMMCfr 1 J AIYV C/t r"LA1en r run yr n... ..v?rs r rvn.a In arr wr ?ncsr am aru.onrnwrna nwr aq <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4-Part form, <br />j -