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PERMITTEE NAME/ADDRESS (Include F"dity NamdLocation if Different) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD J, '4 L u JI <br />LOCATION . ;` P., C0 E33 r' FROM YEAR MO TO YEAR MO DAY <br />r YARD, RECLAI'?AT I ON MAPSAGI= <br />Form Approved. <br />OMB No. 2040-0004 <br />re • <br />F - FV. <br />CHRONIC T1~.51- FOR. <br />lcF+/ 1 3A1 x=?f <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE \\ I: <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertif) under penalty of law that dtis doeument and all attachments weer <br />r <br />d unde <br />su <br />io(, <br />co <br />% <br />ar <br />n di <br />ii, <br />i <br />n <br />da <br />with a <br />i <br />d <br />i <br />d TELEPHONE DATE <br /> p <br />ep <br />e <br />r n <br />rec <br />at or <br />pers <br />n <br />n <br />e <br />r <br />ncr <br />% <br />% <br />em <br />r,, <br />gne <br /> to a+.urr that qualined personnel proprh gather and esaluale the information <br /> cuhmitted. Razed on my inquin of the pennn or persons who manage the system. , <br /> or tho,e persons di-fl.% respmsihk for gathering the inrin- anon. the information - I <br /> <br />suhmitted 1s, to the hest 'or mt km.eledgr and Wirt, true, accurate, and vmpktr. U <br />I I <br /> 1 am aware that thrrc are igntfi-nt prnulties fur .uhmiuing false information. SIGNA RE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED <br />inchwing the Im-ibilin d fine ,nd Imprisonment fur knowing violations OF CER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />lots.c - an o..-..... cn.zo r.arc/ <br />EPA Form 3320.1 (Rev. 39/99) Previous editions may be used. W,, is a 4-Mart form.