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PERMITTEE NAME/ADDRESStl--6*F.rweyHm.WL«aii-tfD06w) <br />NAME <br />ADDRESS <br />1 tilt i4 JU <br />i:,AU l;G d1: <br />FACILITY <br />LOTION .?"D i l i) L 1'1 U h l li (! J CUT? w I <br />n kALI?ADI: CC G1;, <br />I r u T v: r 1\ L tt V. <br />NATIONAL POLLUTANT OISCHMOE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER DISCHMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO I I ,i <br />Form Approved <br />OMB No 2040-0004 <br />k-, .. Ur. L.a) <br />F - FAT AAL <br />rk-b 7 7L L:CLCitl <br />NOTE' Read inatructions belrxe romnlefino this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. UFNCY <br />FREO SAMPLE <br /> O <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . <br /> REQUIREMENT . u <br /> <br /> <br />' SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> ev ± , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT rl_-? -a heal.. CAiI; <br /> REQUIREMENT <br /> I <br /> <br />' SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />k (?.. ! <br />_ <br />>. <br />:. Yr . . <br /> <br />L f, . <br /> <br />t tt . <br /> REQUIREMENT <br /> <br /> <br />' SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT _ irCN7 7 <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ;' J h 2 s z. ,, z, y <br /> REQUIREMENT <br />;. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />' <br />NAME/T(TLE PRINCIPAL EXECUTIVE OFFICER t eertny under Penalty o law Ih.l thh tkurument and all .11seh- <br />Ls wart <br />PPHH <br />DATE <br /> prsp.red under my dlrettbn or wpervhlan In acroed.nce with .system designed <br />- so swum that qualified personnel properly gather and e.alusle The Inrornutlon L <br /> submitted. Bared on m. Inquiry of the person or Persons who man.?e the system. <br /> or those persons dtrertly responsible for gathering the Info tloa. the Information <br />_ submitted Is, to the best of me knowledge and belief, tnre.. mate. and complete. <br /> <br />I <br />.m war. that the" are slgNflnnt penalties for.ubmltttng rains, Information. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />- <br />TYPED OR PRINTED nHudbg the Possibility ornne.ruf Imprisonment r.r knowing .Iol.tior? OFFICER OR AUTHORIZED AGENT YEAR MO DAY <br />\•V1?!!?!Ll?1.e !•.,.v rr?. rr...r...?.. ?. ..._ -.??.... ?..? 1. ... .. ...r. ?.. ?.. ?....... r...r .. wl wr <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used TIIIS IS a 4-Part fOrnl. PAGE OF