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PERMITTEE NAME/ADDRESS (la "FaAiiy Nasss/L-ion f/D(Qbrenr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPOES) Form Approved <br />NAME DISCHARGE MONITORING REPORT IDMRI OMB No 2040-0004 <br />ADDRESS - : < J ; ) <br />PERMIT NUMBER DISCHARGE NUMBER -1 I` AL {•±.. <br />MONITORING PERIOD <br />FACILITY YEAR MO DAY YEAR MO DAY f? F'7 ,??? SAS ?rl <br />LOCATION FROM _ TO <br />NOTE: Rived irntructlons bsfors completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br />EX NCY <br />r <br />? SAMPLE <br />TYPE <br /> AMMAL <br />YSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />- <br />--- <br />- <br /> PERMIT li #ii ?c t# ti ' EFl LJR T ; t r r -} <br /> REQUIREMENT n V ry` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> <br />SAMPLE T F <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 />V <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />MTLE PRINCIPAL EXECUTIVE OFFICER " of pen"I ° law that this document and all attachments were TELEPHONE DATE <br />pr*P.rrd under my direction °r super+tstow In srcordancr with a syslem designed <br />NA E <br />r (- to am" that quallned penonnef properly gather and evaluate the Infnnnallon <br />Based on my Inquiry of the person a persona who menart the system <br />snIt"Ited <br />- - <br />. <br />?. <br />. <br />."hose pr. dtrertly m,,porMble for gathering the Information, the Information <br />knowl <br />th <br />be <br />l or m <br />d <br />nd behrf <br />(r <br />e <br />vratr <br />nd <br />t <br />l <br />t <br />? <br />/ <br />r <br />' <br />•' ?'???- <br />e <br />l <br />y <br />e <br />ge a <br />. <br />u <br />. aa <br />, a <br />comp <br />e. <br />G-- submitted h, <br />o <br />e <br />??? <br />lJ <br />r• ?, ! <br />• <br />. <br />8143NATURE OF fM INCWAL EXECUTIVE <br /> I am awam that them are siigninrant penaltfe, for s"bnrlting robe inronnatlon. A AEA <br /> <br />TYPED OR PRINTED Including the p°?blur? of one and i"'p6mriment for knowing •iofationi OFFICER OR AUTHORIZED AGENT NUMHE <br />R <br />CODE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference tall sttschmsnts herd <br /> <br /> <br />x99) Previous editions may be used This is a 4-part form. PAGE OF <br />3320-1 (Rev 3 <br />. <br />EPA Form