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PERMITTEE NAME)ADDRESS(7no"FwrdlryNa?La ria (fD(Qlwwa) <br />NAME <br />ADDRESS <br />• uG>L lv j u <br />Li AUe: CG d15,4 <br />FACILITY <br />sIUr,* ;vc)aTt: 6 5uJ•tr. rsIhE <br />LOCATION PAL1SALG LU dijz <br />Form Approved. <br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM NPOE3) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /DMR) <br />PERMIT NUMBER DISCHAAOE NUMBER ) <br />ri8A1 Nt: <br />MONITORING PERIOD I C CC 10 R A LC i i V c E <br />FROM YEAR MO DAY TO YEAR MO DAY <br />- <br />NOTE: Read Instructions Wow* corrlplItling this fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br />t <br /> PERMIT <br />• ~ <br />t <br /> REQUIREMENT - <br />A N _ _.. _ <br />i <br /> <br />u SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />' <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> <br />` SAMPLE <br /> MEASUREMENT <br /> <br /> <br />y PERMIT <br />' <br />I; i <br />1 C/ <br />t r <br />i <br /> REQUIREMENT . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />1 [ <br /> REQUIREMENT <br /> <br />r SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT i t•. t(.nT ;„ <br /> REQUIREMENT <br /> <br /> SAMPLE <br />t <br /> MEASUREMENT <br />PERMIT t r:. C! L T r + <br />REQUIREMENT <br /> <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I Mbly ° er penal tf o law that tAh document and aB ajtWhm,ntS were TELEPHONE <br />r <br />d <br />i DATE <br />p <br />epare <br />under my d <br />-tion or wp,,,W- In accordance with • lrslem designed <br /> to enurr that quaitfled personnel properly gathrr and evaluate the Information <br /> sobmltted. Based on m? Inquiry of the person or persons who manage the system, <br /> or thou persons directly mpomibk for gathering the Information, the information t , <br />• _ wbmllted Is, to the brat of racy knowledge and better, true, accurate. and complete. -- <br /> I am ¦.an that there are signlfloal pmaltles for wbmlttfng War Information SIGNATURE OF PRINCIPAL EXECUTIVE ' <br />TYPED OR PRINTED . <br />Including the poodbltttf or Bne and Imprisonment ror knowing vlolatiom OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />I.VMMCra t a nrav a.nr e..rs.. cs ...... ... ..... .... ?.. ...,..... tr..r wr wne.w snr wuwc.runwn ea rrwr .? <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used ThIS,IS a 4-pan Bonn. PAGE OF