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PERMITTEE NAME/ADDRESS Q.,,6A F.,Av,,v w,vL. .rr.w (/D(ow w) NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM frNP0E5I <br />NAME DISCHARGE MONITORING REPORT (DMRI <br />ADDRESS <br />bciX PERMIT NUMBER DISCHARGENLIMBER <br />FACILITY 1 1 AN ?I MONITORING PERIOD <br />l` YEAR <br />LOCATION I A C 0 g 1 ai FROM YEAR MO DAY TO MO DAY <br />LIAM A. RFAR .fR MTISF W.,' <br />Form Approved <br />OMB No 2040-0004 <br />F - FINAL <br />SR; OFER TRL D i C OR UN <br />NOTE: Rmad Irmtrucllonrit h.fnra r•nrnnl.llrtn this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, fREODfNCY SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> P <br /> ERMIT <br /> <br />REQUIREMENT <br />Rr. <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> P <br /> ERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> P <br />M <br /> ER <br />IT <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 /> AEQUIREMENT <br />NAMERTTLE PRINCIPAL EXECUTIVE OFFICER <br />fe^"y 'no" Pena t7 o -f that thf <br />' <br /> <br />repared under my dlrectlon or ?upe <br />s doev <br />menl and .n <br />."arnm <br />..Won In accord.rrn with . <br /> <br /> <br />rrU .ere <br />l <br />. <br />m d <br />l <br />d <br /> <br /> <br />ELEPHONE <br /> <br /> <br />ATE <br /> Jr <br />e <br />e <br />tne <br />to enure that <br />u <br />Mfled <br />l <br /> q <br />a <br />Personne <br />properly lialher and erah'ate IM Informatb <br />orbm111rd. Bawd on my Inquiry of the person or persorn who manage the a)sifm, <br />an <br />e thou Peitors directly MPcrnlb 0 for gathering the Informallen, the Informallon <br />wbmlited b <br />to the bet rrf m <br />kno"*d <br />i <br /> , <br />y <br />V and bel <br />ef. Ime, amrrale• and complete. <br />I a...am that 'hem am signlneanl pen.Itb for wrbmltting r.he Inrormatfew, <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED <br />........var?e. A- -f,# auarrnu nC •1JV vlnl IM*adint the possibility of fine and Imprisonment for knowing Aelattord <br />.Ttnuc m_i___--- _r -•'--`---'- OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />1? APF?Rni?,?rr ?? •/ t?)GCL?, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-part form PAGE OF