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PERMITTEE NAME)ADDRESSQnei-&F.O ry N.oo?L.r.rr.w(/D(fmw) <br />NAME <br />ADDRESS <br />.I5AL)E CC Gl <br />FACILITY :?ilUt tiU:iTi1 t, 50UTri ilt+E <br />LOCATION r? 1'rlLISrUG C?. ?li5 <br />L.LSut4 L. Kjj;j kb. V.P. <br />Form Approved <br />NATIONAL POLLUTANT DISCHAAOE ELIMINATION SYSTEM (/NPOESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT IDMA) <br />PERMIT NUMBER DISCHMOE NUMB <br />En - ( L Je L M C <br />MONITORING PERIOD f ! IC CQA L C b i k K <br />YEAR MO DAY YEAR MO DAY <br />FROM _ TO ? <br />1' ? I <br />NOTE: Read kwtructlone boforo corr?pleting this form, <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOVENCr SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L. .. <br /> REQUIREMENT , <br /> SAMPLE { <br /> MEASUREMENT <br /> PERMIT 1 r / <br /> REQUIREMENT - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT nC <br /> REQUIREMENT L A I L I r". " L C, 'I I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r V ?' ' t <br /> SAMPLE <br /> MEASUREMENT <br />i PERMIT -.- - - niYC <br /> REQUIREMENT ' " 1 I <br />:? SAMPLE <br /> MEASUREMENT <br /> PERMIT E p G <br /> REQUIREMENT -1 v A n I L Y : k <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . * ;. r• , •- 7T-? 71 11 <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I renlly under penalty ° low that thh dotvmenl and all allachments wen TELEPHONE DATE <br /> prepared under my dlrectlon or ouper+lslon In accordann with a system designed <br /> <br />1 - to asun that q..hn d personnel p.W rty golher and ...hrate the Inf°rnytion <br />>n bmllled. ll aaed on me Inquiry d the persona <br />ersons who mano <br />e th <br />ter <br /> <br />' p <br />t <br />e sn <br />m <br />th <br />s <br />lbb f <br />di <br />tl <br /> or <br />ose pence <br />rec <br />y re <br />pom <br />or gathering the Infuematlon, the Information <br /> mbmtiled b, to the best of my knowledge and belle!, true, a mle, and c°tnpkte. - fr <br /> I am aware that then an 511NM1csnt penal"" for wrbmltting robe Information SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />Inctud,ng the possibility of fine and Imprisonment rot knowing eldallotes OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />(.:UMMCI1I0 AFVW Gnr LI\-rrvre ?. .?... .•.+?.?..vre.e to eoo anew err wner..n,nwnw nerrq <br />.L; P}::,CIP. hVi.'l CC:CULzi, SIi:J?I? IC LFLEb C; FECCF <br />EPA Form 3320-1 (Rev 199) Previous editions may be used This is a +-part .Corm.