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PERMITTEE NAMEIADDRESSpweA.&FrWryNa-WLe.uewt/D(#6e t) <br />NAME <br />.. , <br />ADDRESS >I J: C' ! T ii t J t.. _ <br />ty0x 11, it) <br />FACILITY <br />J 1 D E 11 CA'I h G <br />LOCATION <br />PetiLi-iALi (:L blt-4 <br />'k' r [ i v r , <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTUA /INPDESI <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER asCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />r - riis AL <br />PO L 1 7i, CCLurICC biVEi <br />Nf1TF• R..A l... e....-.?.,.,? k-l - --- ..Linn ehl. I- <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQ <br />U <br />NCY SAMPLE <br /> O <br />F <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />EX <br />ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br />_ PERMIT <br />f <br />t T <br />' i <br />(; <br /> REQUIREMENT . .. : <br />t. <br /> <br /> SAMPLE <br />MEASUR <br />M <br /> E <br />ENT <br /> PERMIT <br />/ <br /> REQUIREMENT - <br /> n <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />QUI <br /> RE <br />REMENT <br /> <br />` SAMPLE <br /> MEASUREMENT <br /> PERMIT ;.r...r,._ vv l' ?V `•? `/ <br /> REQUIREMENT <br /> M <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r.. r <br />` f C.:- I <br />, " <br />i I ' <br />F r' <br />r: <br /> REQUIREMENT . <br /> l K <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />1 SAMPLE <br /> MEASUREMENT <br /> RM <br /> PE <br />IT <br />REQUIREMENT <br />rCfo <br />iArl,I- :I <br />i:lY <br />:hnL' <br /> r a ' .t t; <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify n r pens y o law that thb docvmcnt Ind aL aurhmrnu wen <br />d <br />d <br />i <br />i TELEPHONE <br /> prepare <br />un <br />er my d <br />rect <br />on or aupe bilon In areordan with a system dealgned DATE <br /> to ansum that quenned ;,- -4 property Lather and eraluale the Inrormallon <br />sobmllid. Band on my Inquiry of the person r <br />ersona wh <br />na <br />th <br /> p <br />o ma <br />ge <br />e anum. <br />or thou pentrne dimity rnpornible ror gathering the Information, the Information <br />wb <br />llld b <br />t <br />b <br />t <br />f <br />th <br />. m <br />o <br />e <br />es <br />o <br />, <br />my knowledge and belief, true, accunte. and complete. <br />I am aw.- that Irre an algnin"Itt penalilea for submittin <br />f <br />k <br />e Inr <br />SIGNAT <br />F <br /> g <br />a <br />a <br />ormatlon, URE O <br />PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Including the Possibility of nne and ImIprlaonmrni for knowing violations. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br /> CODE <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-part fOrin, PAGE OF