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PERMITTEE NAME/ADDRESS(lneat&FoakjyN.w?Le wiH tJDtp ow) <br />NAME <br />ADDRESS <br />?. 6UX 14jU <br />FACILITY i•1:3 ALlk. Ct•: bi51 <br />C•S1L)_'. i,t,;hi:; i SGJ•Lh ?!1;IL? <br />LocATION :,it r A L I S A Dc cc tj 1 5 c <br />. 1 rfl I.. 1 t rt 1 I. t• n <br />Form Approved <br />NATIONAL POLLUTANT OISCNARGE ELIMINATION SYSTEM NPOES/ OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /D R/ <br />PERMIT NUMBER DISCHARGE NUMBER 1 L n <br />MONITORING PERIOD =- CC 1 ?. F-I ? t h <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read instrvctlom biitford iolnnlatlno this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. EREOUENCY SAMPLE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br />' ` <br /> REQUIREMENT " • ' • <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />C F / <br /> REQUIREMENT N <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t Q r Lb'ArI . ?^tiC <br /> REQUIREMENT <br /> <br />J SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT K i E V h T L r r. ,,„ r.: y <br /> REQUIREMENT <br /> <br /> SAMPLE <br />" <br /> MEASUREMENT <br /> <br /> PERMIT <br />11 n .? i <br />zy rtyf >r <br />ti ;+ :• c <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />t ceriuy . e, penalty .(Is- that thh dorument and .N .tlarhmenh were <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />ared under my di <br />re <br />ction or su <br />,h <br />t <br />I <br />DATE <br />P <br />p <br />re <br />p" <br />i <br />on <br />n arco,,d nm wlth ..y.lem designee <br />to aesure that quanned Personnel Properly gather and e-l-le the Inrnrntatlon <br />abmltted. Booed on my inquiry of the person or person who manage the .y.tem, <br />or those persons directly respomtble for gathering the Information, the Inform.llon - <br />abmilted I& to the beet or my knowledge and be8er, Ime, ar mlr. and complete. _ <br />I am aware that (here an significant penaitles for aDmltNng fahe Information. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Inrluding the poseibtuty of nne and Imprisonment for knowing eiol¦Naea OFFICER OR AUTHORIZED AGENT <br />AFIkA <br />ODE HUMBER <br />C <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />• v • • ? L - e •. 1. ; i v r • ? ? • . t? r lI - r v I• ,. • ? ? 1 .. ? I \. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4-Part fOfin. PAGE OF