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PERMITTEE NAME/ADDRESS(1••AdrFaV6yNa.?(orn,onl/DfQww.q <br />NAME <br />A DORE S S <br />JUA i4 jv <br />FACILITY a :J C V 0.1 <br />111NE <br />LOCATION <br />bA:.t??u:; ?:G bl <br />-. 1 l b. I If i I r <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT fDMR) <br />PERMIT NUMBER ascHARDE NuMEE>+ <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved <br />OMB No 2040-0004 <br />7C l,Ll.! i+ll ri y <br />- ..... ?. ..w.,. w.w s. er..se... v.. vy ? aum ptw.... y -_ .vrrn. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />UE SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT L i L L <br /> N r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ' <br /> REQUIREMENT = y <br /> ,.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> 'J! <br />C <br />C <br /> REQUIREMENT <br />L SAMPLE 1 h " <br /> MEASUREMENT <br /> PERMIT <br /> r. _ _ ?:. s• . , i • ' <br /> REQUIREMENT • _ d 1 <br />? !, _ :' ., <br /> <br />_ SAMPLE <br />M <br />AS <br /> E <br />UREMENT <br />5 PERMIT <br />J REQUIREMENT ,. 4 a, r r G t. ; r r C_ r. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />y REQUIREMENT <br />Y ' L <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' `•""y under p•"•'y ° l.w that u.h <br />preZed under my direction or u <br />" docu ne"' and .u uacnmcnu were <br />vhim In ac <br />d <br />TELEPHON <br /> p <br />cor <br />ance with a tystrrn dalgned <br />to assure that 9-tilled <br />ersonnel <br />ro <br />rd <br />ath E DATE <br /> P <br />P <br />p <br />y r <br />er and evaluate the Information <br />submitted. Eyed on my inquiry of the Perron ac persons who manage the system, <br /> or those per•om directly r-Pornibk for tethering the Information, the information <br />submitted Is, to the best of my tno,.kd <br />W <br />d b <br /> te an <br />e <br />, true, accvrste, and cempkte. <br />1 am aware that there an st <br />rdfkant <br />e <br />lti <br />f <br /> <br />P g <br />P <br />na <br />es <br />or submitting rshe Information, <br />I <br />i <br />l SIGNATURE OF PRINCIPAL EXECUTIVE <br />RINTED <br />TYPED OR nc <br />ud <br />ng the possibility of flee and ImpAtonmrnt for knowing Aolatbru OFFICER OR AUTHORIZED AGENT A AEA NUMBER YEAR MO Y <br />COMMENTS AND EXPLANATION OF ANY VIOL ATIONS lRatforanre, a,N Affsehrys.nfw h..?r CODE OA <br />_,L:' 1.?.1.?. Flirt ?. 1' Fh•i._ 1'1:T!. i. _"c? t, r <br />I M ? tt*. n rEi.(; JEc.,i vCCU.. Jti ?,- <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used Tt1IS,Is a 4-Pan form. PAGE OF