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PERMITTEE NAMUADDRESS p-&*Fa tllryN&w?Ler•tim 1/D(#w-i) <br />NAME <br />ADDRESS <br />.+.%a LIOX 14JL <br />-?ADL CL <br />FACILITY <br />-IDL, itJni ;4 z LUT M IN <br />LOCATION P A L I a A O cc <br />:I'1u i iw I1,rIFi, V . D. <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMA) <br />? ._ A a n ) <br />PERMIT NUMBER DISCHARGE NUMB E71 - FT A A 1 I", E S A <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />.. FROM TO <br />NOTE: Read Instructions before tomnistina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> 1>< OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />C' <br /> <br />• `' <br />r <br />L Y <br /> <br />i t. <br /> REQUIREMENT <br /> is I . n n l' ? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />J <br />i1 C ' / <br />f... f <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t/ r.-c <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r r . , ., _ .., ... 7 U U J ,'•..- <br /> REQUIREMENT <br />v <br />?I Y e, j. <br /> <br />1.71 <br /> SAMPLE <br /> MEASUREMENT <br />l 1 PERMIT l h _ <br />U t:.,'i REQUIREMENT ,. ; ' " A a .. .. <br /> SAMPLE <br />k MEASUREMENT <br /> PERMIT E_bC:.. {rDQn', ti .r r. -vr <br />r Y c^ <br />I b . <br /> REQUIREMENT J U A k a ;, I L Y <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT , <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 rert"y under Pena y .(I.. that thh dorument and all a"arhments were <br />TELEPHONE <br />DAT <br /> <br />prepared under my direrllon or super+lston In acrordanr< with ¦ syalem designed E <br />- to assure that qualified personnel properly gather and evaluate the Ininrnulion <br />submllied. Bred on my Inquiry of the Person or persom who manage the s <br />stem <br />y <br />. <br />or those prrtarn dimtlr respondbie for fathering the Information, the information <br />submllted Is <br />to the beat of m <br />knowl <br />d <br />nd b <br />W <br />t <br />, <br />y <br />e <br />ge a <br />e <br />. <br />lrot, a rvrr. and romplrte. <br />I am aware that there are stgnlfirant penaltle for submitting tube Information, SIGNATURE OF PRINCWAL EXECUTIVE ' <br /> <br />TYPED OR PRINTED <br />Including the po,dblllly of fine and Imprisonment for knowing eloiatlps <br />OFFICER OR AUTHORIZEO AOENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />t,lvmmus t a n,sv ?... ?.-..... , ..... ... ..... r1..1.....?. a.1 vv-..111 ...........r., <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This IS a 4-part forrn. PAGE OF