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PERMITME NAME/ADDRESSQwebbF-akfYNaaf?Leeattae(/D(prer ,) <br />NAME <br />ADDRESS 3 1 1) h lJ r. I tl L <br />• DUA 14 Ju <br />FACILITY ? A U L CC <br />LOCATION : i :J E {i t? ` Z' = L U i h "11 <br />r'ALi5A0s C(I <br />.rl1 t r t <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDCS) <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER ascH'Mot NUMSER % <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />L 1C CCIGi•nCL rIV'F <br />-Hi,h6F. IBC t - <br />Form Approved <br />OMB No 204C-CCC4 <br /> - rev t c: mesa Ine"UCTIor s Csto ro.eWh plstlnp this form. <br /> <br />PARAMETER 7 <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREOOUENCV <br />F <br />SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAL TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT n 1 't i L <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT Y n L E/ ! is c <br /> <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT , ' : it Y <br />F C C t <br /> . <br />, / ! i• :. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT L : _ .. ?. . <br /> <br /> SAMPLE <br />MEASUREMENT <br />{ ft <br /> <br /> PERMIT <br />y REQUIREMENT `t 7 <br />? t h I <br /> N <br />- ._ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT -. r: c F G n i <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER Y o I.w that this document and all .Itachmen6 were <br /> Prepared under my direction or suPenllon in .ccordann with • system deslgned TELEPHONE <br /> to assure that qualified Personnel Property Cattier ¦nd evaluate the Info <br />ati <br /> <br />rm <br />on <br />wnbmltted. tined on my Inquiry of the <br />erson or <br />er D <br /> p <br />P <br />sons who manage the system, <br />t <br /> or <br />hose Persons directly responsible for gathering the Information, the information <br /> submitted ff, to the bet or my knowiedge and beMef <br />trw <br />a <br />srnte <br />d <br /> , <br />, <br />rr <br />, an <br />complete. <br />I am swan that th <br />a <br />ifi <br />i <br />TYPED OR PRINTED en <br />n S <br />gn <br />cant Penalties for setbmlrting raise Information, <br />Includin <br />the <br />oodblHt <br />f fin <br />d SIGNATURE OF PRINCWAL EXECUTIVE <br /> g <br />p <br />y o <br />e an <br />Imprtsonnrw"t for knowing vidatlom OFFICER OR AUTHORIZED A A <br />COMMENTS AND EXPLANATION OF ANY VIOL ATIONS (Reference el/ sftechmsnts herd AGENT NUMMIR <br />CODE <br />nr.C:i V E % I CCCTJ?';? SU.- j t C <br />1L' ?'L! r ?, i : Lt <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-part form- PAGE OF