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PERMITTEE NAME/ADDRESSpwrr&F.rWryN.m./t.°e,rronl/D(06vat) <br />NAME <br />ADDRESS nU,IUt Uniu c I <br />. Je dOX ?v.i(, <br />FACILITY C C <br />1) r. tioI:Trl t f) CUTi: <br />LOCATION <br />il?1 1 _ ? f 1.1 ,. r <br />NATIONAL POLLUTANT OISCHAAOE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT ID RI <br />PERMIT NUMBER DISCHAAGE NUMBER _ b <br />MONITORING PERIOD r <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />unTC• D-d I... <br />Form Approved <br />OMB No 2040-0004 <br />1 11 --- -___,_.I.... nI.I. f-, - <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. UI NCY <br />FREO SAMPLE <br /> O <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT F C is <br />' i L <br /> REQUIREMENT .. <br /> y , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I "r„'y under an•'y ° law that ihh document and it ti.hm <br />prspamd under my dlrerllon or wpervhlon In w ..donee with ¦ nnb veers <br />S <br />nteen desi <br />n <br />d TELEPHONE DATE <br /> y <br />g <br />e <br />to atau" that qualified personnel pnnwfly gather and evaluate 9- Informatlon <br /> wbmllled. Board on my lnqulry, of the person or persom who manage he 3,11,m, <br /> or those Persons directly resporMbie for gathering the Information, the Infor uellon <br />wb <br />ltt <br />to th <br />b <br />t <br />f <br />d h <br />k <br />- m <br />e <br />o <br />my <br />e <br />, <br />el <br />nowledge and belief, true, arty nit, and complete. <br />I am aware that there are Slgnlfleant pmalrl t for mbmllun <br />rais <br />Inf <br />ti <br />SIGNATURE OF PRI <br />CW <br /> <br />TYPED OR PRINTED g <br />e <br />orma <br />on, <br />Ineluding the ponalblllly of floe and Imprisonment ror knowing Aolatlortt. N <br />AL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />A A NUMBER <br />C <br />YEAR <br />MO <br />DAY <br />........e•..Te• ..,n -1 auaTtnu n[ •aIV Vlflt ATtnue ODE <br />s • A ?' .' 4 /• .=. !' 1. ? a t? j ?. 1, ? it .. r .- _ .. .. F { T ?. .. ' .. .. ? i_ . ! ?.. <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used This is a 4-pact form. <br />PAGE OF