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PERMITTEE NAME/ADDRESS(Y e"FmratyNe alL oti-(/D(f6 s) <br />NAME <br />ADDRESS <br />• buA 1v,1U <br />FACILITY SAU.;, cc <br />1r) <br />LOCATION <br />YAL12' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER SI.AARGE NUMBER I <br />MONITORING PERIOD 1 y <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved <br />OMB No 2040-0004 <br />n <br />.: A; ... . <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOLI NCr SAMPLE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ".0 <br /> <br />Alit, <br />11, 1 r <br />` SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> i v <br /> SAMPLE <br /> MEASUREMENT 1 - <br /> PERMIT <br /> REQUIREMENT i t :...? <br /> <br /> <br />` y SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT l ...t : .: r. <br /> <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT ' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />_ <br />REQUIREMENT I :: F (, , ' •• <br /> i <br /> SAMPLE <br />MEASUR <br /> EMENT <br /> PERMIT <br />n[ k C : <br />i <br />V k 'I <br />. <br />_r <br />REQUIREMENT i1 <br />Am kd? <br /> <br />dm menl ¦nd .11 au.cnment .ere <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I cr wy ° er I, .. fly o Is. that is <br />TELEPHONE <br />prepared uthat nder mr dirertion or super W_ In accord-nn with ¦ s)ateln designed to a>!Yrs <br />ualified <br />e <br />o <br />nel <br />" DATE <br /> q <br />P <br />rs <br />n <br />"'It <br />7 gather and eealtrste the Inrormallon <br />aoDmltted. Based on mr Irpulry of the person or persons who -na <br />. the <br />t <br /> g <br />,m. <br />y <br />or (how Persons directly responsible for gathering the Information, the Information <br />submtlted Is <br />to the b." (. <br />kn <br />wled <br /> , <br />y <br />o <br />ge and behrf, Irv., accurst., and connpleie. <br />1 am a..- that there am si <br />nificant <br />en <br />lti <br />f <br /> <br />R PR <br />NT g <br />p <br />a <br />a <br />or atnDMtting rate infonmtlon, <br />In <br />l <br />i SIGNATURE OF PRINCWAL EXECUTIVE <br />I <br />ED <br />TYPED O c <br />ud <br />ng the poaslDllll) of fine and Imprtwnmrnt /or knowing rlolauorrs OFFICER OR AUTHORIZED AGENT AREA NUMBE <br /> R <br />CODE <br />YEAR <br />MO <br />DAY <br />rnMNAFNTS ANn FXPI ANATION OF ANY VIOI ATIONC ta.?.....,...a .ee...w...._._ t.___t <br />i.r..1. ;. FO.i AL!rkiNATL LI"ITAIIUtr?i ?,h <br />:iEE L.A.I. <br />UYh??4r;Ei rit::C?t ev,;hl UCCI i, 5JJJIFCI TU BL <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-Pan form, PAGE