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PERMITTEE NAME/ADDRESS(7-A4farWq No-WLoeaHaml(D(Owe s) <br />NAME <br />ADDRESS <br />oux 14ju <br />FACILITY D i 1 u t+ ii 1 G v; 'i r ,1 h >r <br />LOCATION +}: FALi it Or. CC old. <br />Form Approved. <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM ((NPOES) OMB No 2040-0004 <br />DISCHARGE MONITORING REPORT WMR/ <br />PERMIT NUMBER DISCHARGE NUMBER - Fl ` A L 4 e, <br />MONITORING PERIOD IC CC LC Fi A CC F? r: r: <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION ND, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT r i.. <br /> REQUIREMENT <br />. <br /> e <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 /> <br />'° allschmenO were TELEPHONE <br />NAME/'TITLE PRINCIPAL EXECUTIVE OFFICER ' """' ° "p`""y ° I.. `"" this document and <br />DATE <br />prepared under my dimilon or super+lslon In a ordann with • system darned <br />to assure that queened Personnel Property gather and evaluate the Infremiatlon <br />sobmllled. Based on my inquiry or the person or persons who manage the system. <br />1 <br />or !boar pe directly, responsible for gathering the Info /loo, the Information <br />submitted Is. to the bat of my knowledge and belief, true, se mlr. and complete. -) <br />1 am ...re that there are stgnlnrant penalties fm ruhmitdng htse Information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> , <br />lbfll <br />d 1 <br />t <br />h <br />r n <br />d, <br />1ni <br />TYPED OR PRINTED e poai <br />ty . <br />"e an <br />mpr <br />u <br />sonot r- knowing .IOl.uo s <br />ne OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Ur AnT VIUL,n I IONS f/fererence err errocnmenrs hers/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This 1S a 4-part form. PAGE OF