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PERMITTEE NAME/AO SSpnn?id.f rygX.+.'L«wlen ((DNATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM (NPDESJ <br />NAME DISCHARGE MONITORING REPORT ID RI <br />ADDRESS <br />' b Di( i 43c-. <br />PERMIT NUMBER ascHMOE NuMeER <br />i'A;-i=ADE Co 81524• <br />FACILITY ROAfiS I DE f 4ORTH ?- SOUTH 111 NES MONITORING PERIOD <br />LOCATIONNE R PALISADE `- r Et 1 r: n. FROM YEAR MO DA TO YE A14 MO DAY. <br />. I .J='_LS©N L. KIDDER, V. P. <br />Form Approved. <br />OMB No 2040-0004 <br />(SUBR UW) <br />F - FINAL <br />ROADOIDE 700T1-•s TO CC)i._U P:[VER <br />NOTE: Read instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS - <br /> SAMPLE <br /> MEASUREMENT <br />- <br />?' <br />_ <br />?? - - - T <br />- PERMIT <br />REQUIREMENT fJ I MUM IX I Mt.il <br /> <br />}= ENDLD SAMPLE <br />J <br />` - I? <br /> MEASUREMENT <br />30 .1 C! PERMIT ' <br />t <br />NT R`1' S ES <br />U rid At.'!' I•I <br />D, 4 1 i.. ' <br />- <br />41 <br />Xf` REQUIREMENT <br />4, <br />062 <br />FE i <br />SAMPLE <br /> <br />r' <br /> MEASUREMENT <br /> <br />: <br />v f GRO c cj ?- PERMIT <br />- REQUIREMENT <br />c <br /> SAMPLE <br />11 <br /> MEASUREMENT <br /> <br /> PERMIT n1?, M, (A <br /> REQUIREMENT <br />•. .. <br />_ : <br /> <br />A <br />' <br />: SAMPLE 2, <br />; <br />', <br />I-•j R: i R i=. <br />TMFP:T R L A" <br />' MEASUREMENT <br /> <br />17t1 <br /> PERMIT <br />REQUIREMENT <br />- <br />- ; <br /> <br /> <br />SSOL'J [ C` SAMPLE <br />Ir <br />I I % ?: <br /> MEASUREMENT - <br /> <br /> PERMIT a?'? f;'•;' wit`:;. <br />EFf LUFI REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />_ PERMIT <br />REQUIREMENT <br />I ctrvly under penalty o aw that NN dorurrwnl and all stlachmeno were <br />d TELEPHONE <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER <br />dire <br />d <br />d <br />m <br />ti <br />n w <br />Asion In - <br />,d.- with . <br />tte <br />desi <br />n <br />r <br />J ' <br />DATE <br />p <br />epare <br />un <br />er <br />y <br />c <br />o <br />sup" <br />ty <br />m <br />g <br />e <br />* <br />_ to nature that quagned personnel properly gelher and evaluate the Inroematlon <br />I <br />submitted. eased on my Inquiry of tht penes or persons who manage the system. <br />(i ! - <br />( - -' <br />or those pert ms dtnetty ravportdbk foe gathering the information, the information _ <br />- ' <br />r; - -i'- submitted h• in the beat of my knowkdgt and better, bete, amrrale. and eompktt. <br />SIGNATURE OF MINCWAL EXECUTIVE <br />fi <br />l <br />1 <br />i <br />f <br />i <br />r <br /> gni <br />aft, Infortnatlon• <br />am aware that then are s <br />cant penalties <br />or wrbm <br />tt <br />ng A A <br />TYPED OR PRINTED Irtcludtn t tM podbtttty or fine and Imprisonment for knowing riolatlotn. OFFICER OR AUTHORIZED AGENT NUMEIER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS /Roforonco all ettachmonfs hotel <br />5`r'ENDF_D 0L.I1DE65 1' TSa <br />This is a 4- art form. <br />EPA form 3320-1 (Rev. 3199) Previous editions maybe used p