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PERMITTEE NAME/ADDRESSpnrb4fordbryX...'L oi(-(fD(p ,) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPOES) <br />DISCHARGE MONITORING REPORT IDMR) <br />7,777 <br />k, <br />PERMIT NUMBER ks,HAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read Irmtruetlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO <br /> <br />EX fREGUENCY <br />Of SAMPLE <br /> <br />TYPE j <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br />r <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 />NAMEmnE PRINCIPAL EXECUTIVE OFFICER ' "f1"" ' p•"' 1y ° Lw that this doatment and all all.rhments wen TELEPHONE DATE <br />prepared ruder my dlrertloo w wper•lsloa In s ordnnn with • system dafirwd <br />to .sewn that quallned p monnel I, op, I gather and...Io.tr the Intormatlon <br />wbr,411 d. Shed on my Inquiry o! the person or persons who mange the syelem, <br />Of Ih°se persons dimity -Potdbk For gathering the Inronn.lln°, the Inrormallon <br />-- wbmltlyd I& to the but a my k"'aWte and beet. Irne, ae< -W and tornpiete. <br />SIGNATURE OF ?RINCIPAL EXECUTIVE , <br /> I am .wan that then an vjonrant penanla for wbmitting fake Intonnaub . A A <br />TYPED OR PRINTED Incln.dlnilhepodblutyornn..ndbnprt.on,Kntto.?no.lnr.ld.uw*s OFFICER OR AUTHORUEO AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANA 1 wn yr nn r v1vLn.lvrva tnerwrmcs aa...nes n.,,..nrna .,"r", <br />EPA Form 3320-1 (Rev 3)99) Previous editions may be used This IS a 4-Part form, PAGE OF