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PERMITTEE NAME/ADDRESSpwe&*Fac*tyNa-?Laearcaw((D(#Wwo) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (INPDESI <br />NAME DISCHARGE MONITORING REPORT IDAo R) <br />ADDRESS iJ':. c f1 F- I <br />BOX 483 PERMIT NUMBER DISCHARGE Nt1MSER <br />1A MONITORING PERIOD <br />FACILITY E- NO 2 M I r YEAR MO DAY YEAR MO DAY <br />LOCATION 1A FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br />M INOF <br />c SUBF <br />F - f <br />Gf-r, DI <br />NOTE: Raad k+atructiom Wore eomplotfng this form. <br /> NO NCr <br />fRE0 PLE <br />S <br />PAR <br />METER QUANTITY OR LOADING QUALITY OR CONCENTRATION , OF AM <br />A EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT f <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> : 717 <br />-, PERMIT :- <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ti <br /> PERMIT r <br /> REQUIREMENT Ft' ir, ; w;` ' I a <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> M <br /> PERMIT <br /> REQUIREMENT !'.0NTi•i <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> v. <br /> PERMIT R TE 0 r . - t:... <br /> REQUIREMENT ,' j? • . <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT 1 ' TR MAY <br />CIPAL EXECUTIVE OFFICER ' "' ` a"•'y ° law that tl eh documenf and all ¦Itachrnenu were TELEPHONE DATE <br />NAME.lTITLE PRIN prepared ender m7 direction or mprstilsion in acewdann with • system darned <br /> to asnum that qualified personnel property Lather and evaluate The Information <br /> submitted. bawd on my inquiry of the persom or person who emanate the system, <br /> or those persons directly respordbk for gathering the Inrormsllon, she Information <br /> submsilfed k• to the bat of my knowledge and be W, true, accurate. and t pkk. <br />NA <br />EXECUTNE <br />IN ' • <br /> 1 am aware that there are significant penalties for wbmining W. Information, SIGNATURE OF PR <br />C <br />L AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED lnAudlnt the possibility of floe and Imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT CODE <br />COMMENTS AND EXPLANATION OF ANY VIVLA I IVN5 (morarence an arrecnmonrs nirripf <br />FIP?FrTP 1','l NI IEF rq ATM!-T), Tr* CI.ATM APPROk)Ej? PY W(3CD, <br />is a 4-pan form. PAGE OF <br />_ This <br />EPA Form 3320-1 (P.ey 3/99) Previous editions may be used