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PERMITTEE NAME/ADDRESS (7nrr4 Fedho Nnn.VLxatlw IJDtdbrwa) <br />NAME <br />ADDRESS <br />JvA 14jv <br />'jo - IeAUc CC tilt) <br />LOCATION ILlSIL)' +(.j hfh t, jCUTh MIi+t.- <br />rALZjADe cc dlb <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT fO RI <br />PERMIT NUMBER OISCHAnoE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />(Subi+ L:) <br />F - FIIt AL <br />F(;,+U n iC C0 LO it AIC i I V k A <br />NOTE: Read Instructions befews completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. fREOUENCY SAMPLE <br /> OF <br /> EX ANAlvsts TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />I <br />L ti <br /> REQUIREMENT •r •.r <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />(. t / <br />t <br /> REQUIREMENT R <br /> a <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />L <br /> REQUIREMENT <br /> t <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />' <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />("N" I 1 SAMPLE <br />r MEASUREMENT <br /> PERMIT L :. i it k U ?T <br /> REQUIREMENT <br /> F r _ X <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I `?ntq u er pena y o law that Ihb document and dl au¦chmrnls were TELEPHONE <br />l DATE <br />prepared under m) direction or cups- v <br />cm In s-ordance with ¦ system designed <br />to aSauey that quallned personnel properly gather and evaluate the Info mallon <br />aobmltted. Based on my Inquiry or the Person or pernoru who manage the system. - <br />or those persons dlrrt117 responlble for gathering the Information <br />the information j <br />, <br />submitted Is, to the best army knowledge and belief. true, accurate, and mmpWr. <br />F <br />1 am aware that there ¦m significant pe asides for submitting raise Inform¦Ilon <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED . <br />Im+uding the poadblNty of fine and Imprisonment roe knowing yWatsoni OFFICER OR AUTHORIZED AGENT CAFIEA OOS NUMBER YEAR MO DAY <br />COMMENTS ANL) LAI LAMA I IvN yr nn r V IWLP% I tuna frfererence off errucnmenrs nerej <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-part form PAGE OF <br />i. -_.. .