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NAME <br />ADDRESS <br />:i LI C i .? u <br />SADE CCi <br />FACILITY :-'SIDE NORTH & SOUTH M1 <br />LOCATION PAL -T`J1" ADE cc <br />SON +.. F fDEER I V. P. <br />Form Approved <br />NATIONAL POLLUTANT DISCHAROE ELIMINAT10M SYSTEM NPOESJ ,, - - - <br />DISCHARGE MONITORING REPORT IDA?RI I 1 I j` ` OMB No 2040-0004 <br />(Sc <br />F - <br />3 PERMIT NUMBER DiSCHAP41 NUMBER <br />J C iLOI? ?iD Ll F I?1 <br />F3 I PS MONITORING PERIOD <br />YEAR MO DAY Y AR MQ DAY <br />FROM TO <br />NOTE: Read Instructions blitfor• complet" tltds form- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT - <br /> <br />i PERMIT <br />P1 i N L fl'. i' <br />mA k I MUM <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT X <br />1\1?T MA <br />F: LUEN I vkGb' S VAL-1._1' REQUIREMENT 45-4. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />DA IL• <br />;fix <br /> REQUIREMENT ..DA r K. <br />r. <br />SAMPLE <br /> MEASUREMENT <br /> <br />i PERMIT - ( MAX <br />- <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 cerl'ty "'&f pe"- y ° aw lfiat thh davmenf and ap ¦tlachmenLS were TELEPHONE <br />prepared under my direction or sup9, a " In areordarste w1111 ¦ system darned DATE <br />to inure that quaNMd personnel properly gather and evaluate the Inrmmatlcm <br />- <br />? .. . <br />submitted. Bred on my Irpulry, of the person « Panora wh° manage the system, <br />J <br />or those persaro directly respo Wbk for gathering the Information. the Informelirm <br />. <br />'•t - - mbmllted Is. la the bat of my knowledge and Wlef. Iror. a-mle. and compMt. - <br />IIN <br />EXECVTtVE <br />IPA <br />I I am a.are that there an slrNncant penalties for submitting fake Information, C <br />L <br />SIGNATURE Of M A A <br />HUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED Imiuding the poadblllty of nm and Imprisonment for knowing vloladorm OFFICER OR AUTHORIZED AGENT CODE I <br />COMMENTS AND EXPL.ANAIIVrf yr nn. ,--rr..LJ u,.r... J `-jUI- <br />- PAGE OF <br />EPA Form 3320-1 (Rev 3199) Previous editions _ ,F.1