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PERMITTEE NAME/ADDRESSp-A.&F&eAty v. WL-.01-(/D(06- ) <br />NAME <br />ADDRESS <br />`? :•IF+Ti_ Ili 1.{;tr,+?.Y l.! <br />KER <br />FACILITY rY : I ;') t ;`:1 <br />LOCATION : aK. C, _ f <br />LL <br />L?' JEC;S, VP Of <br />NATIONAL POLLUTANT DISCHAAGE ELIMINATION SYSTEM Alm <br />DISCHARGE MONITORING REPORT (O m <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEA MO DAY YEAR DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />f I NOR <br />t SIJBR . JC ) <br />? - F I NAf_ <br />PRQcr cCT SS%) PD, 40gr No C; <br />NOTE: Reed knauctlom boioro eompWing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUEIICY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT ! <br /> PERMIT Pt to t? I", <br />- <br /> REQUIREMENT ?(;Ja AVG !)A! L Y ; . <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 />TIriE PRINCIPAL EXECUTIVE OFFICER ' " "> "We' pe"", ° I•w that thb docvmrnl and all atlashmrnts were _- / `- -- TELEPHONE DATE <br />pmp.rtd under my di-11.n or SuPerelsloen In artordonct with a system desaened <br />NAMEl <br />1. Ma r that q..Hn d personnel Property plhee and -0vote the Infnens.lle" <br />of the person or Persona wh <br />sobmttted <br />Bard "n m <br />In <br />uir <br />rns- <br />e the s <br />stem <br />y <br />q <br />y <br />r <br />. <br />. <br />o <br />y <br />-• a Ihwe Perswe dlmtly responsible for E.lhering the lftlc atlon, the Informsllen DYE - ? y <br />submllled le, to the best of my knowledge and belief. [rut.. rste..nd mmpMr. <br />IONATVRE OF PRINCIPAL EXECUTIVE <br />r <br />y ?- <br />/ I .m .wort that there am dgnifleant Prnatdts for vubml:fing (else InforsMElon. E A A <br /> <br />TYPED OR PRINTED <br />Including the possibility of Mae and Imprisonment fee knowing Ael.tlona <br />OFFICER OR AUTHORIZED AGENT <br />CODE HUMBER <br />I <br />YEAR MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference sat attachments here) <br />- ?a Pk' -F, -VENT IS CLAIMED. IF ?_L_A7M APPROVED BY WaC" <br />c - SEE I. A. <br />EPA Form 3320-1 (Rev 31") Pfevious editors may be used 01 IG , '-' i` -.-!W15 aA-p.M SOTm PAGE OF