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PERMITTEE NAMEJADDRESS(t r"F.r+rpA.+. tae•uPe(/ny`..nu NATIONAL POLLUTANT DISCHARGE EUMINATION SY9TEM //NPDESJ <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS U <br />PERMIT NUMBER DISCHARGE 1IVM6ER <br />_ISADL b. .. <br />ADS 1 DI- MONITORING PERIOD <br />FACILITY YEAR MO DA Y A MO DAY, <br />LOCATION R PALIaADE - FROM TO <br />?:'LSON L. AIr', <br />Form Approved <br />M I N D [ % OMB No 2040-0004 <br />L: <br />I - FINAL <br />ROAD:.;IDE N12 34 iO COLD <br />NOTE: Rssd Imtructions Wors completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br />EX FREOuENcr <br />OF SAMPLE <br /> <br />TYPE <br /> ANAlrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />lIl <br />f r 1 u .;:? VF?t_ <br />REQUIREMENT H I N i MU;-' MAXI MUM <br /> <br />"' - SAMPLE <br /> MEASUREMENT <br />i <br />! <br /> <br /> <br />` 1= '= L_ .. t?` .: • Ai.- `-' PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> _ <br />c-L <br />L! •, . PERMIT ?, iJ' <br />j Y 1x <br />_)A 1 , . <br />Apin REQUIREMENT <br />- SAMP( -F <br />I SUAL <br />- MEASUREMENT <br />1 <br />14066 1 d <br />r FLUENT GROSS PERMIT r tj1)X G' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEf"nE PRINCIPAL EXECUTIVE OFFICER t ttf" y " nckr pen"r ow that this dotamrnt and all attachments .ere <br />TELEPHONE <br />DATE <br />PRP.,.d under my dlrvru.n of 0-p-1,110. In s-ordanm with a system desilmd <br />l h 1 r., i^; to as>un that quaBned Penonnei Property gather, and e•atuate the !.remotion <br />submitted. Stawd on my Inquiry of the person or persons who manage the system, <br />- - <br />- •. ? <br />or lhoae persons dlrertle responsible roe gathering the Information, the Informallon <br />submltlyd K to the bnt Or my knowledge and belief. Irtle. ecru-I.. and complete. <br />` 1 am a <br />re that there ¦ <br />sf <br />nifk <br />SIGNATURE OF PRINCNAL EXECUTIVE <br />nt <br />altl <br />bmittin <br />r <br />t <br />I <br />f <br />f <br />t <br /> wa <br />m <br />g <br />a <br />ptn <br />es <br />or su <br />g <br />a <br />e <br />crma <br />n <br />f n, AAEA <br />TYPED OR PRINTED Including the posdbtitiy or fine and Imprisonment foe knowing .lolatlorea OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRef4ronc• 0 •ttechmenta hotel <br />?'?? U :?C)L I D5 t T:?S 3 <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used , This Is a 4-part form. PAGE OF