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PERMITTEE NAME/ADDRESSpwoYii rWryNanr?L ation(/Dtf wv) <br />NAME <br />ADDRESS <br />c01 1a ju <br />1SAJr. CC bit) 1( <br />FACILITY <br />D5IDr: !+?a i' v cj E ESib <br />LOCATION •.:i 1r A L I S A L)t cc u 15 E <br />I N 1 r l t• L L v n <br />Form Approved <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM /rNPOESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMRI <br />W) <br />PERMIT NUMBER DISCHARGE NUMBER t A i M C <br />MONITORING PERIOD IC CL. LC, P A L C ?I I V E b <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Road Mstructions Wore 6oMplstinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. NCY <br />FREO <br />U SAMPLE <br /> O <br />f <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />t r <br />Lill <br /> REQUIREMENT <br /> <br /> SAMPLE <br />` <br /> MEASUREMENT <br /> PERMIT J IL <br /> REQUIREMENT <br /> r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. t. r? v :? r - t L i <br />/ n r <br /> REQUIREMENT <br /> li <br /> <br />,.,.? SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT xX1=tc1 r: <br />A i- <br /> REQUIREMENT <br /> AV T <br />t SAMPLE <br /> MEASUREMENT <br /> PERMIT .. ; r 1 C A <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />1 U i) PERMIT _ i-c - h it 10 hT . ;. 1 <br />' REQUIREMENT <br />U y <br />1 II <br /> SAMPLE 1 <br /> MEASUREMENT <br />!- r C <br />PERMIT ., nGF'C: _ r GFtZ i ;I. 1 <br />REQUIREMENT <br />ti !, A <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER ' cenuy u der penalty o N. that thin dorument and all .n.chnrent, were TELEPHONE DATE <br />prepared under my direction or wpenlsfon In accordanxe with . system designed <br />In ensure that qualified personnel properly gather and evaluate the Inforsnatlont <br />_T- submitted. Bred on my inquiry of the person or persons who mana <br />e the s <br />stem <br />g <br />y <br />. <br />- or those persas directly responsible rot gathering the information, the Information - <br />submitted Is, to the bet of me knowledge any belief. true. oevurote. and complete. <br />1 am aw.- that then are dgNnc.nt F-Ititles for mbmltNng Won Information <br />SIGNATURE OF PRINCWAL EXECUTIVE ( . <br />TYPED OR PRINTED . <br />Including the possibility or line and Imprisonment for knowing vlol.tlc a OFFICER OR AUTHORIZED AGENT CAREA ODE NUMBER YEAR MO DAY <br />GVMM[fY 1 J Af'IV C/tr t?1nn t tv.• v. .-.... ..vas ..v n.a In.raerncr. srr wtrwr.nnrwnra nwrq <br />EPA Form 3320-1 (Rev, 3/99) Previous editions may be used. This. is a 4-pan fOrtn.