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PERMITTEE NAME/ADDRESS t7nc&k Farfbfy No-WLar.ti n I/DDQGrrnlf <br />NAME <br />ADDRESS <br />...r. bUA i4J j <br />iSADL CG d1b. <br />FACILITY <br />LOCATION ?ALl?ACL L? d15? <br />;fih1 ( _ T 1 I i <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (INPOES/ OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER - F I N A L C l <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructlontit bsforo,complsting 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 /> ,. <br />u 1 SAMPLE <br /> MEASUREMENT <br />y PERMIT C r / <br />- REQUIREMENT <br /> K z <br /> <br />r SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT '? h, i f! C 1 : r <br /> SAMPLE <br /> MEASUREMENT i <br />1 PERMIT r. ! I L .i : '. C a <br /> REQUIREMENT <br />L iY <br />LNIh <br /> SAMPLE <br /> MEASUREMENT ` <br /> PERMIT - <br />P ` ' <br />' <br /> <br />- i <br /> REQUIREMENT <br />1 ,, . ,• _, t i SAMPLE <br /> MEASUREMENT <br /> PERMIT _ F t/ f:rL` . .. ? . / i , i . <br /> REQUIREMENT r V U 11 Y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , : n 1 `t r <br /> REQUIREMENT <br />o <br />NAMEfnnE PRINCIPAL EXECUTIVE OFFICER I nntly under pen. try ° law that this 6 <br />rumenl and .11 allachmenb were <br />d <br />i TELEPHONE DAT <br /> <br />prepare <br />under my d <br />ncllon or supenbion In accordance with a system designed E <br />_ to 'Warr that quallned penonnef property gather and eealusle the Inrmnm tlon <br />submitted. Based on my Inquiry of the person or persom who manate IM s <br />tirm <br /> y <br />, <br />or those pereore dimit <br />res <br />onsible for <br />therin <br />th <br />I <br />f <br />i <br /> y <br />p <br />ga <br />g <br />e <br />n <br />ormat <br />on, the Information <br /> submitted Is, to the beat of me knowied(e and beBef, 1r . a mfe, and complete. - <br />- I am aware that then are signlncant prnsifle for subMlting robe Information. SIGNATURE OF PRINCIPAL EXECUTIVE ?-- <br />TYPED OR PRINTED Inciud(nt the possibility of floe and imprisonment for knowing eiol.dom OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />VVmmLler V r,reV ??• ?r,..r.,rv.. ?. ..... ..??....?..? . ?. ?. ?rrrw wrr ?..?....r..wrr•u rrwr wr <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This,is a 4-part form. PAGE OF