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PERMITTEE NAME/ADDRESS pne6&FedMryH.+?L«ero . ((o(b-ro ) <br />NAME <br />ADDRESS <br />• ?• CLIA 44 )v <br />.I:;ADL 1-C <br />FACILITY <br />•..U:,lUL illitt•itl G JT N I!1 <br />LOCATION H k A L I i P. L t (i, <br />?L?UN L. n1L?ttr Y k <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI <br />DISCHARGE MONITORING REPORT (D RI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MID DAY TO YEAR MO DAY <br />Form Approved <br />OMB No 2040-0004 <br />(aL <br />F - <br />NOTE: Reed Instructions before eompletlny this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. U <br />NCY <br />RREO SAMPLE <br /> O <br />F <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -- <br /> REQUIREMENT <br />r <br /> <br />r SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />t / <br /> REQUIREMENT r' <br /> v <br />? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r-Lt 41 e. ?i.L <br /> REQUIREMENT Y (? " L h <br />e SAMPLE <br /> <br />t MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> Ir <br />-Y X iy C , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT :. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 certly under pe"a ly .(I.. that thb d°cumenl and aE anachments were - <br />TELEPHONE <br />DATE <br /> prepared under my direction or supervision In accordance with • system designed <br /> to aware that qualified personnel Property tether and evaluate the Information <br /> .obrdtred. Based on my Inquiry of the <br />erson or <br />wh <br />erson <br />mana <br />th <br /> P <br />p <br />s <br />o <br />ge <br />e sntem. <br />th <br />tl <br />di <br />f <br />i <br /> or <br />ose pervom <br />rec <br />y respons <br />ble <br />or gathering the Information, the information <br /> submilted h1. to the best of my knowledge and belief. true. amrrate. and mrnpiele. j <br /> I am aware that there are significant penaittes for submitting robe Information, SIGNATURE OF PRINCIPAL EXECUTIVE !l <br />TYPED OR PRINTED Including the poinibility of fine and imprisonment for knowing vioiatloen OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> CODE <br />nsrsf <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-Pan for-in. PAGE OF