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PERMITTEE NAMEIADDRESS(lk"F*Mky)Va-WL«artaae((D($Ww t) <br />NAME <br />ADDRESS <br />.;6 J01 14 JU <br />..l?hl?E LL Nib: <br />FACILITY <br />NL."1n t SVUIh :Ilit J <br />LOCATION In VALISALc t.J did. <br />1 ".1"L 1 L' T - L 1. <br />Form Approved. <br />NATIONAL POLLUTANT 04SCHAAGE ELIMINATION SYSTEM I/NPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER ascHARaE NtrMeER y <br />F'hki <br />MONITORING PERIOD IL CC LO b A L C fi I lili h <br />YEAR MO DAY YEAR MO DAY <br />FROM <br />i I I TO _ <br />NOTE: Reed Irntruatlone bsfore,coirlpleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. EREOUENCY SAMPLE <br /> OF <br /> EX °LYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />r; <br />. <br /> REQUIREMENT . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />1 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT O i tr J ti; i, r l..". 'T t. C <br /> REQUIREMENT <br /> Y <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ;„-. - <br /> REQUIREMENT <br /> 1 ^F <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT T. .? •; + . - t. <br /> REQUIREMENT <br /> <br /> <br />/ SAMPLE I <br /> MEASUREMENT <br /> <br /> PERMIT <br />?) (: r : <br />L L L ti ^. <br />:.. <br />?; i '[ <br />•. v ; n <br /> REQUIREMENT <br /> :t <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT rL <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rer„y under penalty o law that Ihb doeument and dl attachment, .ate <br />TELEPHONE <br />DATE <br />prepared under my direction or wpentalon In attordanc'e with ¦ system designed <br /> to scours Choi quallned personnel property tether and esaluele the Inronnallon <br /> aabmltled. Bred on my Inqulry of tM person oe persona who manage the system, <br /> or those prrsom dlmetly mponsIble roe gathering the Informatlon, the Inrormatlon <br /> submllled Is. to the best of my knowledge and belle!, Ime, a mle. and complete. <br /> I am aware Chat there are olgdnrant penolttea for submitting robe Informatlon SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED . <br />Including the possibility of tine and Imprtsomnent for knowing .Idatloce> OFFICER OR AUTHORIZED AGENT CAREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />GUMMCIV 10 Ar'sU cnrl?'1nn t wee v. ..... ..... a... • .v.w 1-are-or"'. ane wa ua.ranewna? nwr azy <br />c / <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This is a 4-Part form. PAGE OF