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PERMITTEE NAME/ADDRESS(Iarb&F&-*JyNan-ILxatiwr11D1pfresrrQ <br />NAME <br />ADDRESS - y_ <br />•1.f• uUX 14 J(, <br />aJ? ?. <br />FACILITY <br />-I D b h U fi'; t: 6 SIL.ii T h ti 4' <br />LOCATION <br />E'd..FSArJL: CL <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT WMR) <br />PERMIT NUMBER DISCHARGE NUMBER r E <br />• i . l <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO v <br />NOTE: Read Inetnictlorm beforr'`r,.- nlatina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREOUE Cr SAMPLE I <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. <br />- ! . L L t ` <br /> REQUIREMENT <br /> T Nil Is, J, 1 <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />I C.1 , <br />C c <br /> REQUIREMENT <br /> <br /> <br />e SAMPLE <br /> MEASUREMENT <br />J <br /> PERMIT <br />.. ? <br />.. ., <br />.... <br />/ .. ? 4 <br />= / <br />! ?'. <br /> REQUIREMENT <br /> -,TLY ilk <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />i. r E C <br /> REQUIREMENT <br /> c <br /> SAMPLE <br /> MEASUREMENT <br />. <br />` PERMIT FL/;.; i{t i c h <br /> REQUIREMENT <br /> U is <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER fe"'IT " ` ve"• ty ° la. that thH "'em a"d `u'Itachmcnt? ..en TELEPHONE <br /> <br />prepared under my dlrertlon or supervision In Itmordann with • system desipKd DATE <br /> to assure that qu*Hned personnel Properly Lather and evaluate the Infoemallo , <br /> mbmflted. Bred on my inquiry or Lire Person or persuru who manage the system, <br />th <br />l <br /> or <br />ane persons direct <br />y rssponslble Im fathering the InFetrmatlon• the Information <br />b <br />d le <br />itt <br />t .. I <br />( <br /> su <br />m <br />e <br />e, to <br />he best of my knowleAge end belief, true, aceunle, and complete. I <br /> I am aware that there are dgnIflunt penalties for wbrrtttdng falar Information, aIONATVRE OF PRINCNAL EXEcuTNE <br />TYPED OR PRINTED Including the podblllty of fine and Imprbonmenl For knowing AotsUorsa OFFICER OR AUTHORIZED AGENT CAREA1 ODE NUMBER YEAR MO DAY <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is a 4-part Am. PAGE OF