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PERMITTEE NAME/ADDRESS l/nrlu& fa64ty Aamu?Q.o('arion of ItiffrrrnN NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT WMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER :AL <br />0 KOLL r7I TC <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before <br />Form Approved. <br />OMB No 2040-0004 <br />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 t C <br /> REQUIREMENT <br /> SAMPLE <br /> <br />MEASUREMENT f <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ! <br /> PERMIT - . , A!" <br /> REQUIREMENT <br /> SAMPLE <br /> <br />MEASUREMENT _ <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ?. ,• k_ R <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT /z, I. l Tti <br /> PERMIT _ r r- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t. <br /> REQUIREMENT - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cerlift under penaln -d iaw that mis dt-menl and all attachments wrre <br />d <br />d I _ - r TELEPHONE DATE <br />_ prepare <br />un <br />er m'i th-1-n or -jwr%ision in Art ordance, with a stem dmigned <br />?? ? .` `4 '1_ i_? _?.-- • `? _:? <br />. In assure that yualifitvl Ixuvnnnrl properh gather ;uul rt uluate the information <br /> submitted. Rnsrd on m, ,qui n of the q•rs(,n or perwms who manage the -tem. <br /> <br />'1. or th- Irnom timed. -pfmmihlr ror gathering the information, the infnrmntirm , <br /> submitted is. I., the 1-1 .'f m) km,wlydge and Wief. true, .crania, and complete. <br /> <br />I am uwuro that [here a <br />-i <br />ifi <br />m <br />x• <br />hie <br />f <br />iui <br />f <br />l <br />h <br />i <br />f <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />- 6' <br /> <br />TYPED OR PRINTED gn <br />r <br />ca <br />l <br />nu <br />ur su <br />m <br />s <br />ng <br />a <br />se <br />ormat <br />n <br />on. <br />including the Ixusibilit} -l rme and imprisonment her knowing iolalw s. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />YEAR <br />MO <br />DAY <br />......?..? _ CODE <br />AIVU CAt-LAI`IAI!Uri Ur- ANT VIOLATIONS <br />a?I attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-part foram.