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PERMITTEE NAME/ADDRESS(/Ae&&F.edryAr..?L ofo-(fD(pbewo) <br />NAME <br />ADDRESS <br />Li0X ius,; <br />?ISAG:: cc <br />FACILITY D51 DL N J H i n 6 ? U u I r. n I <br />LOCATION h P A L i A L L CL <br />i czV,H 1 i(T ? V_ L'_ <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESI OMB No. 20404)004 <br />DISCHARGE MONITORING REPORT IDMRI <br />J .. •, a. A <br />PERMIT NUMBER DISCHARGE NUMBER <br />F1!J?L <br />MONITORING PERIOD h <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Reed Instructions before Mpletlnq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> of <br /> <br />EX NALYSIS <br />A TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT . , <br /> <br /> <br />u ` SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT J i e / .: t• <br />v REQUIREMENT (.: ` <br /> SAMPLE <br /> MEASUREMENT <br />y PERMIT c , r. F, E F G n 1 t: i/ <br /> REQUIREMENT r I L h ;t <br />Y <br />r'i f <br /> SAMPLE <br /> MEASUREMENT <br /> <br />1 PERMIT _ .4 : , . 7 O U 0 it ?.: / r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 1' l L a : ' <br /> REQUIREMENT <br /> <br />e i SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT hLiU.._ P 0 h T <br /> REQUIREMENT A Y vAILY !X <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT ... - ;; n <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' `v""' ° " a"' ty ° Lw ma u,ln donvment and all attachments were TELEPHONE DATE <br />Prepared under my dlr tlon or super.lstOn In acvord- with a system designed <br />to Aare that qualined personnel properly gather and evaluate the Infrn tlon <br />submitted. Based on my Inquiry or the person or persons who manage the system, <br />or Most <br />ersons dim fl <br />res <br />onsible for <br />atheri <br />th <br />inf <br />ti <br />th <br />I <br />f <br />- <br />p <br />y <br />p <br />g <br />ng <br />e <br />orma <br />on, <br />e <br />n <br />ormation <br />,ubmttted ", to the best of my knowledge and belief, tmt, a rate, and mmplete. <br />I am .ware that then are signinr.nt pe..itir for subnrttin <br />rater inr-lien <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> , <br />g AREA <br />TYPED OR PRINTED 1-luding the poadblltt, or nne and tmprtannment for knowing .lni.unm OFFICER OR AUTHORIZED AGENT ODE NUMBER <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION Ur AMT VIULA I Ives Irfsrsrence M arracnmenrs ners) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is it 4-par( form. PAGE OF