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PERMITTEE NAWADDRESS(f er4rf.rWe?lvwr?LxrnowUDldrwr)?+ <br />NAME <br />1I <br />ADDRESS <br />!= _ IBADE !=J <br />FACILITY I DS I DE NCJR- H & ,;-! . ' N M I <br />LOCATION -,R PAL ISADE °-? <br />Sore i_ r?DER, <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM- fNPDES/ Form Approved <br />OMB No 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />•? i i 1.!'lJ <br />PERMIT NUMBER 04SCHAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY EAR O DAY <br />FROM TO <br />NOTE: Reed Instructions before completing this fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY <br />OF SAMPLE <br /> EX "-TYPE <br /> IALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT M : N i (IL"i1i 1.- <br />?A_.•J. REQUIREMENT <br />_ SAMPLE n y? <br /> MEASUREMENT - <br />' PERMIT :i?iDl1 r?t?:? i)r`. a 1 - r^ X <br />i•! i _:? - . ; ! <br />: REQUIREMENT <br />REQU <br /> <br />r <br /> SAMPLE i l <br /> MEASUREMENT <br /> PERMIT A <br />c } <br />' REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />1 <br /> SAMPLE b <br /> MEASUREMENT - <br /> <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />_" PERMIT <br />C <br />iJE-N REQUIREMENT <br /> <br /> SAMPLE iX <br /> MEASUREMENT <br />f <br /> <br />PERMIT <br />REQUIREMENT <br />AMEITITLE PRINCIPAL EXECUTIVE OFFICER I Rnely w d., P•.. y o .- that thk de.aemenl and alt.IIwhrnnlta were TELEPHONE <br />prepared und.r my direction or fuprr+lalon In aeeord.ner -Ilh . ayatem deatgned <br />N DATE <br />_ <br />to a - that 9-11ned personnel properly father .nd eeatuate the I.fnrmatlon <br />-bmitlee. Based sn my Iny.,l.y.fthe pcr or per,or.. who ".age the ryaum, _ <br />_ or Ihore persona dlrectly r pomlb* for patherln f the Info-11. ,the Inform.llms <br />1, ( sub"Wited k, to the bet of my k.owkdge and bellef• tr , .ecaerale• and compkte. <br />IGNATURE OF PRINCWAL EXECUTTVIE <br />_ I .m .— th.l there .re atgNnt¦nl p-Iflea wr eubmltring fat. Information. S AREA <br />NU WKR <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED IMkwI.f the po.dblllle of nne and Imprfaonmenl for knowing ekrl.Uort> OFFICER OR AUTHORIZED AGENT CODE <br />COMMENTS AND EXPLANATION OF ANY VIULA I IVNJ IKererenc, off Wtlecnr"W"IJ "Wiwi <br />f <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used f h 1 1 ? .; - p;i ! t 1 t ; : 'AGE Of