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FERMITTEE NAME/ADDRESS0-A-4F-rAdyNa.?L«.ti-(fD06,-q <br />NAME <br />ADDRESS <br />FACILITY !w :' i1 1'' i, f•I!_ <br />LOCATION ER <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM /rNPDES/ <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER aSCHARQE NUMBER <br />MONITORING PERIOD <br />YEAR DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />NOTE: Reed Inetructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. U <br />ENCY <br />FREG SAMPLE <br /> O <br />f <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT <br /> S A MPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 nnhly a nder pens Iy o la. Thal this doeomenl and all sltachm ft were <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />DATE <br />prepared ender rnr direction or auperelalon In accordann with a a <br />ystern designed <br />to Gaon that q.aMfhd personnel Properly Lather and e.ah ele the Informalton <br />1 <br />Y l? ?' •? ,obnrlted <br />Sewed on m <br />in <br />uir <br />or the <br />erson m <br />r <br />wh <br />(h <br />A <br />q <br />y <br />p <br />. <br />y <br />pe <br />son <br />o ?.ge <br />e sy3tem. <br />ar thou penem directly responsibie for gathering the Informatlnn. the Infonnalion <br />1 - subentiled K to the bet of ny ?no.l.d it and belief, Iroe, accurst,, and cornplete. <br />!L- % - I . n -n that then Ire drnlnc 1 p Irle rnr .ubnWill. <br />Ww Inrorr <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />dl <br /> g <br />ne <br />. <br />+ <br />TYPED OR PRINTED ? nt Inc posdblutr or nnr .,A:mprisonment ror k-.ing Anl.tlw <br />^ OFFICER OR AUTHORIZED AGENT CODE NUMOER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Referenclr off errechments here/ <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is a 4-part form. PAGE OF