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PERMRTEE NAME/ADDAESSpwei4f rwgx..?t«,nonl/D?Qinnn) <br />NAME <br />ADDRESS <br />FACILITY ) L rj G ei l: ?t'1 t, 5 ( V .i 1' r i :: L <br />LOCATION P A i Z 5 A L c C. G t <br />Si?"e i.. K;::I,Ph_ v_:._ <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTDA //NPOES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /DMR/ <br />PERMIT NUMBER DISCHARGE NUMBER _ h L t t . <br />MONITORING PERIOD , s Z L L. Oil L C h c k h <br />YEAR MO DAY YEAR MO DAY // <br />FROM TO - <S <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOOUFNCY SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERM <br />T <br /> I r .".: E r. y <br /> REQUIREMENT IN, .j ` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> P <br />RMI <br /> E <br />T <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br />i <br />NAMErnTLE PRINCIPAL EXECUTIVE OFFICER 1 ---ly a " r Penalty o (I.- that <br />ts document and dl ¦tbchmenB were <br /> <br />P"P¦rerf under my di-11- or au, lkllon In ¦ccord¦rrte with • arstem designed <br />In assure th¦1 <br />ualifi <br />d <br />l TELEPHONE DATE <br /> q <br />e <br />Personne <br />property gather and feNu¦le the Infmr alion <br /> submitted. bred on my Inquiry of blf Person or Persoeu who man¦tte the sralfm, _ <br /> or tho¦f Peas directly MPordb4 roe 9¦thertnt the Inform ill°n• the Information <br />submitted la <br />to the best of m <br />tn <br />wkd <br />d <br />' <br /> . <br />y <br />o <br />ge an <br />belief, tree, a,r-mle, and, Piet.. <br />1 ¦m aware that then are dgrof1r,nt penNnes fo <br />brrotn <br />f <br />l <br />I <br />" <br />- <br /> r wr <br />ng <br />a <br />se <br />nformatlon, SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Inrtudin[ the poadbillly of tine and Imprisonment for knowing violation. OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MO DAY <br />r^naI.IC IJTC •IJn FYDI •u•Tlnu OF ?NV VII-Ill ATIrI AIC /O./.,_...._ _x Ir CODE <br />L. 1 1 <br />HcG 1LYk.?+4Hfi rh:lIP. iyc:+i GCCL <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This -is a 4--P8r1 (OFRI.