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PERMITTEE NAME/ADDRESSpwaYbFwrWryNwWLe oti-l/DlpFlnq <br />NAME <br />ADDRESS 1 !i <br />,. ?jw A.4JU <br />FACILfTY I:oADL CG <br />LOCATION Dz; IDc NU I-. r, ?CUri:H mIt. <br />:t pALll,AD : CU <br />I -.1`tu at r Vii: L U :, <br />Form Approved. <br />NATIONAL POLLUTANT OISCMARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /DMRI <br />PERMIT NUMBER DISCHARGE NUMBER N n <br />MONITORING PERIOD - 7C CL LC F A L L I v <br />YEAR MO DAY YEAR MO DAY _ <br />FROM TO <br />NOTE: Read kvatruatlorm Wowiba-fnpleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, NCY <br />FREG <br />U SAMPLE <br /> EX O <br />f YP <br /> ANALYSIS E <br />T <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />• `' <br />41 <br />L : <br />i 1 i ' <br /> REQUIREMENT , <br /> SAMPLE <br />' MEASUREMENT <br /> <br /> PERMIT / Ir ( L / b f t <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />+ L i' Cr <br />L/ <br />h h <br /> REQUIREMENT - . <br /> , <br /> SAMPLE <br />I ` <br />r MEASUREMENT <br /> <br /> PERMIT <br />•` ?` i <br />:,U u <br /> REQUIREMENT <br /> w I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT I r F AL <br /> < ,.. . ^ <br /> <br />' - SAMPLE <br /> MEASUREMENT <br />I i:.ATesi.NI F i <br /> <br />i PERMIT <br />., . J <br />n <br />i ; r z, <br />x L Y r <br />... <br />:r <br />i i•. <br /> REQUIREMENT <br /> <br /> <br />' SAMPLE <br /> MEASUREMENT <br />ti <br />PERMIT <br />REQUIREMENT <br />' <br />T ? n <br />s <br />1 remit) under penalty o law that ihh document and all allachmenu were <br />NAMEMnE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />DATE <br />Imporsd under my dlrectlon or suprrOslon In accord- with • system designed <br />to assure that quaNlled personnel property Lather and evaluate the Informellon <br />submitted. bawd on my Inquiry of the person or persons who manage the system, <br />or those perveem dlractiy mponsIble for gathering the Inforvttallon, the information <br />submitted k, to the best of my knowledge and betlef, true, accunte. and complete. i <br />- 1 am aware that the- ars slrnlncartt penalties for submllling fake Information <br />SIGNATURE OF PRINCWAL EXECUTIVE <br />- <br /> . <br />Incomi <br />th <br />lbltil <br />r Il <br />d I b <br />t <br />TYPED OR PRINTED ng <br />e poaa <br />y o <br />m an <br />mprtsonrernt for knowing vloiatlores. OFFM:ER OR AUTHORIZED AGENT -Umm R <br />m <br />m YEA R MO DAY <br />COMMEN I5 ANU EAYLAMA I turn yr ^1r •rvt.n t rvna Inarrarre,ncar art arnncnmmta nerrn/ <br />EPA Form 3320-1 (Rev. 349) Previous editions may be used This is a 4-part fonn. PAGE OF