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PERMITTEE NAME/ADDRESS (7r m6& F«YfryN..?L wati- tfD(ft t) <br />NAME <br />ADDRESS <br />OUX i4.3U <br />_.I?AUr cc <br />FACILITY 5 t, u 'l ti :: I <br />Lora,TtoN <br />_ F t y r e 1. r. tr <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (INPDES) OMB No. 204040004 <br />DISCHARGE MONITORING REPORT WMR) <br />PERMIT NUMBER DISCHARGE NUMBER _ F I b A 1 C. E A <br />MONITORING PERIOD CC A l C h E f K <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Irmttvctions before coirlpistinp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. fREOUENCr SAMPL <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT r kT Y . _ <br />% ` 1 <br />u <br /> REQUIREMENT <br /> MAY <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMElTiTLE PRINCIPAL EXECUTIVE OFFICER I ctf1t " of pen' ty o 1iw that this dotin1tn1nd all iIt"h-ft "trip TELEPHONE DATE <br />prepared under my dtreetbn or supr-Won In accordance with a Systems designed <br />to sure that qualified personnei Property gather and evaluate the Information <br />_ submitted. Bawd on my Inquiry of the person or persons who nn.nage the system, <br />or those perso to distily respondble For gathering the Informauom. the Information <br />submitted im, to the best or my knowledge and belle!. true. ec[urale. and complete. <br />I am were that there ere Slgninramt Perseus for submitting Abe Informauon <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />Including the po,dbwt, or nrw and Imprisonment for knowing vtotauons, OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMV4 I b ANU CAr'L.ANl9 I IUn yr n11 1 -1- 11vre.7 fntrrtersncs rr enecnmenfs nwrs/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-part form.