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PERMITTEE NAME)ADDRESS (?-" Faelbry Noa+JLorarfm I(D(6Iwwv) <br />NAME <br />ADDRESS <br />i:;AJt <br />FACILITY <br />LOCATION <br />' . f t A I . it r f` T 6 AL o r. <br />Form Approved <br />NATIONAL POLLLrTANT DISCHARGE ELIMINATION SYSTEM NPOESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER - ` r i N A L <br />H !: <br />MONITORING PERIOD T C C C A L C F E f R <br />FROM YEAR MO DAY To [YEAR MO DAY <br />lUnrC. o__i r,.,... <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. NCY <br />EREG SAMPLE <br /> GE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />h ': <br />s v N .. <br />r <br />i t <br /> REQUIREMENT , <br />_ . . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAMEfnnE PRINCIPAL EXECUTIVE OFFICER I rerldy u er penalty .(I,. that tA <br />prepared under my dlrerllon or mpe. b dorvmenl and au attach'tswere <br />i - In accordance with • evetem dM <br />n <br />d TELEPHONE DATE <br /> g <br />e <br /> <br />. to man that quallllyd penonnef properly gather and evaluate the in(o tloa <br />mbmllled. Bawd m m,, Inquiry or the person or pera who mana <br />e the <br />u <br /> g <br />er <br />em, <br />ar thou penom di-fly mporelbk for gathering the Inrormallon, the lnrormallon <br />sub <br />itt <br />d h <br />t <br />th <br />( <br />,. _ m <br />e <br />, <br />o <br />e bnt <br />my knowledge and bebef, true, atevnte. and lompkle. <br />I am swan that there ¦n slgdM1cinf penafffea for mbmflti <br />r <br />pe I <br />r <br />t <br />iIONATUR i <br /> <br />TYPED OR PRINTED ng <br />a <br />n <br />orma <br />lon, <br />Including the pneefbllll• or fine and Imprf o rnw.l for knowing Nolatlo E OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AOEKT <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br />DAY <br />arTn am cVOI aal•Tin?1 nC ?IJV \/1 nl ATInaIr` rn _t:_____ CODE <br />CUs: All EhNAiL L_ -4; F PiliCIFa 4VEN'I CC CLfl-:;, SU;:jEC'.'I U i:UaCih Li rt<CP <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />This is a 4-pan form. PAGE