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rERMITTEE NAME/ADDRESS(1wer&F-thryy--WL-oti-(fD(06een1) <br />NAME <br />ADDRESS <br />_.1 L. i rt [ tY <br />_ Z:If,tFir till <br />FACILITY O? ?? -1 M j Fa <br />LOCATION C Q <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPOES) <br />DISCHARGE MONITORING REPORT (OMRI <br />PERMIT NUMBER 0NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY [YEAR MO DAN <br />FROM TO <br />Form Approvoid <br />OMB No 2040-0004 <br />F <br />f_`t Il .^.H is ?J=71 T °(lfvn,,c-nnr- <br />NOTE: Read IMtrucdone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOVENCY <br />SAMPLE <br /> <br />EX of <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> - <br /> PERMIT i +Ir1r; { <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />NAMEMTLE PRINCIPAL EXECUME OFFICER I certify under pen. 11y, o ?"Nu Choi Chli dacutnent and all atlachmerwo were <br />Prepared ander my direction or-p-hilou In aecotd.M wllh a tyetenr dWgred _ <br />TELEPHONE <br />DATE <br />J l f .- / <br />f' to assure that qualtned Fwmnnea Property gather and t-luale the tntormatten <br />f <br />h <br />b <br />I <br />i ?•_ ?? J` >, <br />r ` <br /> nqu <br />eu <br />wdited. Board on my <br />ry o <br />t <br />e Person or peraoeu who manage the system. <br /> <br />r -, <br />or then Wrootto dtretny reeporrdble for gathering the Information, the Information 71 <br /> w/mlated K to the beet of me knowledge and Keller, true, accurate, and eomPkle. <br />I am aware Chat them are etgNricont penalnaa for sabmttnn <br />rater intornutlon <br />SIGNATURE OF FRINCWAL EXECUTIVE <br /> g <br />, <br />I <br />d <br />ili <br />I ARE <br />TYPED OR PRINTED n <br />wding the Possib <br />ty of nor and <br />mprtaon rent roc knowing eiotatiom OFFICER OR AUTHORIZED AGENT ODE NUMBER <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION Ut- ANT VIVLA I IONS (Reference ed attachments here/ <br />;R PRECIP V;?NT 15 ('!_AIMED IT CL-41M ANPROVr=i WO[;;. <br />7- C7 Z: <br />c; <br />Igor <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used - Th16 YS a 4-pail f6rm. PAGE