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y; <br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME <br /> <br />ADDRESS <br />='?vSr'C r i ?b: <br />1 .'ii ?6Ju <br /> <br />7 L 0R ER NC <br />FACILITY <br />c. r? ss r 4t° } C'?1W <br />I,,.'•i.??7.}t t? F`i <br />LOCATION q y <br />t."6 '?!- ??LITk t.:l• t.? P1. .'i ?1. ?Y klt (AI.: Pt <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DA1R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO . DAY YEAR MO DAY <br />FROM (L Q&!• U'i TO t;?a ate <br /> <br />Form Approved. <br />OMB No. 2040-0004 <br />Sufi v M S! <br />l Siu,",'.'R fore <br /> <br />70 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />P? SAMPLE ' kr^ f .k 3 `r?: 3 S ri ...'• s ii t -' <br /> MEASUREMENT <br />0104300 1 ?w PERMIT <br />VEx.e REQUIREMENT <br />T {. L; r.- <br />SO'... 1"S, SAMPLE `. # , .. d i? .r i •.w r 4 25) <br /> MEASUREMENT <br />,?SQF;' ?? 9 f;;! PERMIT <br />;. <br />??i_4e 1?1i REQUIREMENT <br />e- sl '_ <br />CL el <br />OIL NDr?f:"? r SAMPLE <br /> MEASUREMENT <br />.3 582 1 Ci 0 PERMIT <br />?.tt-??s'. i!'v•i `'-'•'v?i',?J ?]' VA1..Irjr REQUIREMENT 3+.-n is d's'' °!i_ t• :"`??? :?{i; i>; ' <br />FLOW y ?N '.! s'itr!,. a ,:1 SAMPLE 4o-J ti w .' w'^.: :tZ is ka : fs. i'.•3 i. <br />THRU T RHA"T'S'I1INT PL AA;'-: MEASUREMENT <br />sS s :':l PERMIT _ 3 irk" <br />": <br /> <br />e.a 0 w.i ?e..D ?I?r?L.. ?.?'•' <br />)EFFLUENT REQUIREMENT <br />1'V?'c. <br />- .?) <br />?•:l:t,:I ? •.? <br />"+' <br />OIL., AN'.i}" Gi' SAMPLE `74g <br />V %Sh. P^ MEASUREMENT <br />640d.;1ii 0 PERMIT 1 _ l <br />1 1_t?, 57 `I?03r VA 1 REQUIREMENT * . # :0-0 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT i <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHON E DATE <br /> prepared under my direction or supervision in accordance with a system designed <br /> <br />RichExd A. Munson to assure that qualified personnel properly gather and evaluate the information <br />b <br />i <br />d <br />B <br />d <br />i <br />i <br />f <br />h <br />h <br />h <br />a <br /> <br />d <br />9 su <br />m <br />tte <br />. <br />ase <br />on my <br />nqu <br />t <br />e person or persons w <br />o manage t <br />e system, <br />ry o <br />or those persons directly responsible for gathering the information, the information <br />," <br />??L <br />n <br />723$ <br /> <br />O? <br /> <br />®? <br /> <br />o? <br />ViC?' PpCS <br />dent b <br />i <br />d i <br />h <br />b <br />f <br />k <br />l <br />d <br />d b <br />li <br />f <br />d <br />l v <br /> su <br />m <br />tte <br />s, to t <br />e <br />est o <br />my <br />now <br />e <br />ge an <br />e <br />e <br />, true, accurate, an <br />comp <br />ete. <br />I am aware that there are si <br />nificant <br />enalties for submittin <br />false information SIGNATURE OF: PRINCI AL EXECUTIVE <br />TYPED OR PRINTED g <br />p <br />g <br />, <br />ncluding the possibility of fine and imprisonment for knowing violations. / OFFICER OR, AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />OOMMENTS ANU tXPLANAI IUN UI- ANY VIUL.AI IUNb (Hererence an arracnmenrs nere) <br />r' T' .,; r ?J.'1 S f ..r!Y?.r} e?'•'i.c ?'°??: '.' •l:? ??CYI EVEt,t a:J1.l6Jr":..= !" Yr' St' Pts(#'O:" =: <br />?' ; a i 1 -tt _ ?y: s f y r ( iJ;i ( <br />. :V'tv:)-?.k.E:?? LrY?". J• <br />. 'tP _..i l.: . . <br />P {?'R '?+ .!. u <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. T. :r I ,, rr. .3r?}S: i? 4- Wk orm. PAGE OF