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PERMITTEE NAME/ADDRESSt7-"ForeNryNe.?Locrtewl/D(96t) <br />NAME <br />ADDRESS <br />. ?• bvX 1.4Jv <br />LI:;ADc. CG <br />FACILITY ti :i 1 L t i4 U h T tt b'CU T h lI i <br />LOCATION ;ti PALi::AUt, :.C <br />:.Ll)uN L. f,ILCer, V.11. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (/NPDESI <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br />(Jvlyit Lu) <br />F - FI <br />xt <br />NOTE: Read k»tructlone beforecoMpletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L I _ <br /> REQUIREMENT <br />L <br />_ e t <br />YAx1 <br />_. , SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />_ PERMIT k C ! 'I <br /> REQUIREMENT n 1L <br />i t <br />'+ T r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -? _ :, .Yr t? v U 7 . V O <br /> REQUIREMENT I L 1 C X <br />-, SAMPLE <br /> MEASUREMENT <br />L ! U PERMIT ` <br />L) REQUIREMENT ..+ i G A X <br />LU: SAMPLE <br /> MEASUREMENT <br />t, PERMIT F G E C F. <br />_ _r.L2 <br />"Th <br />y • REQUIREMENT ; i L Y <br /> SAMPLE ) <br /> MEASUREMENT <br /> <br />PERMIT :r f L'C• - rC rL r; r <br />REQUIREMENT A A <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' re^ny under Penalty o ass that th6 document and all atlachments wrre <br />prepared under my direction or fupenMon in accordann with a system designed TELEPHONE <br />DATE <br />- to aware that quattiled personnel property gather and evaluate the Informallon <br />sub <br />itt <br />d <br />B <br />d <br />In <br />ir <br />f th <br /> m <br />e <br />. <br />re <br />on my <br />qu <br />y o <br />e prrson or persons who manage the system, <br /> or those perms directly respomlb c For gathering the InformaUo., the Inrorrnallon <br />- submitted Is, to the best of my knowledge and better. Ime. a mle. and complete. <br />F I am aware that there are significant penalties for submitting rate Inrormatlon SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />Ir wiuding low possibility of nnr and Imprisonment rw know Ing vlolauom OFFICER OR AUTHORIZED AGENT A A NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aN attachments here/ <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used. This IS a l-p3rt.forth. PAGE OF