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PERMIME NAMEIADDRESS pnc4i F.rWryN..?L«.nen t/Dt# . w) <br />NAME <br />> <br />ADDRESS _ <br />• bL X 14 .v <br />FACILITY L U t :? J! is 0 V v'i 11 <br />LOCATION PALISAUh <br />CI fi 1 r: E 1. f'. F f. d _ L _ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI <br />DISCHARGE MONITORING REPORT /O RI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br />(:,UDr ?I%I <br />F - F AL <br />t•Cti% 7 1C CCLC'n1!L. 11? <br />NOTE' Read Instructiorrs bsl(x• como)stina this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. UFNCr <br />FREO SAMPLE <br /> D <br />0 <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX rsls <br />ANA TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />J. U <br />t <br />D: I i J <br /> REQUIREMENT Y <br />ti I <br /> <br />N <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT n t k C r T <br /> REQUIREMENT y ` h T <br /> SAMPLE <br /> MEASUREMENT t <br /> PERMIT :•??4q _ -i tiara= ?v CG?lYA -[ h? <br /> REQUIREMENT <br />?.:: i,ti _ <br />lat? 1 <br />r SAMPLE <br /> <br />... <br />._. MEASUREMENT <br />? <br />V <br />J PERMIT !Gh; I;-ic'r.T :R <br />r, L Y <br />' h; i r. . <br /> REQUIREMENT <br />y A V!, T Y <br /> SAMPLE <br />t <br /> MEASUREMENT <br />i PERMIT rt [. FU h'i' [ r ' ' <br /> <br />v REQUIREMENT <br />s <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I rentiy " er pen. ty o I.w that this document and all atla hments were <br />TELEPHONE <br /> <br />DAT <br /> prepared under my direction or supereNon In.ccordanse with . system designed E <br /> to mom that quallned Personnel property Lather and evaluate the Information <br /> submined. bred on my Inquiry of the person or person who manage the system, <br /> or those persoro directly rsspondble for gathering the Informatlom, the Information ' <br /> submitted Is. to the best of my knowledge and belle(. Im., atcu-Ir. and complete. <br />I am a-am that there are significant penaltle for submitting fake Inforvatlen, - <br />SIGNATI.)RE OF PRINCIPAL EXECUTIVE <br />- - <br />TYPED OR PRINTED Including [be poadblBly of fine and Imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT COOS N<lMBfR YEAR MO DAY <br />> Jti. r e r r. .. 1? • :-y C.t Z 'CC:,'!g fir ? i.t 'T > . ?• f t ..L <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-part form. PAGE OF