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PERMITTEE NAME/ADDRESS Qaebfr F«v lryr vm w ? wia (1D(&_,) <br />NAME <br />ADDRESS <br />•'?• UIJA LW J V <br />_1 aAD <br />FACILITY , i U L I.'J 11 T h E <br />LOCATION P A L I ? a re <br />NATIONAL POLLUTANT DiSCHAAQE ELIMINATION SYSTEM ((NPDESI <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHAADE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />(?ubh :.w) <br />Fir.AL <br />LCAL Crt_K <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUNCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> ' 1. U. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> <br />MEASUREMENT f <br /> PERMIT <br /> <br /> REQUIREMENT <br /> i A. Y h A t N T h <br /> SAMPLE ( . <br /> MEASUREMENT <br /> <br /> PERMIT <br /> r ; U U <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT t <br /> <br />... SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT ; f. <br />.. SAMPLE <br /> MEASUREMENT • <br /> PERMIT <br /> REQUIREMENT <br />L <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER nd <br />' K""` " er pen¦'y ° l¦' th¦t thi <br />prepared under my dlrvellon a eu <br />- s do um¦nt ¦nd ¦11 iwhmenlf +e" <br />lA <br />In <br />TELEPHONE <br /> p <br />cm <br />amord.nre +fth ¦ yet.- designed <br />to assure 111.1 qualified <br />ersonnel <br />r <br />rt <br />th DATE <br /> p <br />p <br />ope <br />f ga <br />er and e..lv.te the Information <br />eubmllted. Based on my inquiry of the person or per one who nmen.ge the syllem. <br /> or thaw peesora directly re,porelble for gathering use lnformauon, the lnrorm.uon <br />submitted le <br />to the bet r - <br />kno-W <br />d <br /> , <br />y <br />ge en <br />better. Im.,.mn.le. end c pkle. <br />1 am a- IAN them see ef <br />nlfkanl <br />en <br />lef <br />f <br /> g <br />p <br />a <br />es <br />or eubmltnng faker Information. <br />I SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED ncluding the penlbltly of fine and Imprisonment for knowing e1ol.ueem OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOL ATIONS fRata-r. --T arr.?Aer....r. f,-.-1 CODE <br />l.n.i.ca p,,, r.LI=hyAT6 Lit: i'1n 1l,Iti17 Yf;i:.I lt.{N., ii! i -;:T e L I CL.. r <br />?. J cC.: TC LhI,F? E errr? <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used T111S_IS a 'L-Patt form. PAGE OF