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PERMITTEE NAME/ADDRESSpnel.rf rUtryNa-WL eti-1/D(ff-,) <br />NAME <br />ADDRESS <br />? V X a v J U <br />_?AU? CL <br />FACILITY <br />3IUc 4", t1 <br />c. ??Jlt1 :i: <br />LOCATION P A i.1 S A u i cc <br />Gflfi t e l r I- _ It <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER [DISCHARGE Nl1MeER <br />` MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />L 5 FROM TO <br />is CCI <br />?:: t.G i:I?Cr.6,FsGP (X? <br />Form Approved <br />OMB No 2040-0004 <br /> <br />PARAMETER <br />QUANTITY OR LOADING ..m t cc naaa inswucLlom aato <br />QUALITY OR CONCENTRATION re-com <br />NO. phnnp into <br />FREOOUFENCY torm. <br />SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <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 /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMnE PRINCIPAL EXECUTIVE OFFICER I certrty under pe.. ty o law that this do ment and all ¦ttwitments were <br />Prepared under my dfrsctlon <br />,m <br />r <br />u <br />I <br /> o <br />s <br />pe. <br />cm <br />n aceord.nce with a systern designed <br />I- assum that qualified Personnel Pro"FlY gather and <br />v <br />luat <br />th <br />I <br />f TELEPHONE DATE <br /> <br />- <br /> <br />- e <br />a <br />e <br />e <br />n <br />ormation <br />submitted. Based on my Inquiry of tM per,,,, or person, who manage the system, <br />or those perxr, directly ,e porolb4t for gathering the Informaliow, the Infoernallon <br />submitted Is, to the best of my knowled <br />e and b <br />f <br />I <br />li <br /> g <br />e <br />e <br />. <br />mc. accurate. and complete. <br />1 am aware that ther <br />e <br />l <br />Nll <br />l <br />' <br />TYPED OR PRINTED e ar <br />s <br />p <br />ean <br />penalties for submitting false Information, <br />Includin <br />th <br />o <br />ibilit <br />f M <br />I SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL g <br />e p <br />ss <br />y o <br />m and <br />mprtsonnwnt roc knowing vlofatlona <br />ATIONS (Reforenc? @# •ftachments here) OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO DAY <br />1.!ial.0. FLIh ALIEHNAT:, LltllTA11 !v:i Wt1l <br />.,UlitE.14i - ii.E I . A , 2 , <br />,.4 4'1A F74CIP. ctir:t <br />f <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.