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PERIYIITTEE NAME/ADDRESSt?n. eFarlNryNa.-JLe wie I/D(06wv) <br />NAME <br />ADDRESS <br />I . AER Cri 8164 <br />FACILITY 'r} Y' 9 M Np <br />LOCATION .!•i-ER' C b H 1 E.4 <br />-I-L- Y 17 SANIDEW-, VP OF OF S <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES/ <br />DISCHARGE MONITORING REPORT (D RI <br />PERMIT NUMBER ascHAnGE NUMBER <br />MONITORING PERIOD <br />YEA51 MO DAY YE MO DAY <br />FROM TO <br />Form Approy" <br />OMB No 2040-0004 <br />NOTE; Read :nstructione before romnlatlno this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />_ REQUIREMENT l9: a `: I i 1, h; <br />- SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT i !_. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ',. - - - <br /> REQUIREMENT <br />Av_ <br />Mcl; <br /> SAMPLE -- <br />r_ MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT !_'t` f7X ; ;Of.4 1 <br /> SAMPLE - <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT y=•-._ MAX GENT <br />- SAMPLE <br /> MEASUREMENT <br /> ;M <br />#ii # <br /> PERMIT r <br /> REQUIREMENT j tri! # MOW <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I -bly Y ei P,-0117 o I.w thal this doaoment and dl ¦llwhrre <br />Prepared under my dlreetbn or fuPervhton in .reord.m, with . nt, were <br />¦ <br />,tem de <br />l <br />d <br />'-•a ? TELEPHONE DATE <br /> y <br />a <br />tm <br />. . <br />_ J • '-, ; 1 / <br />7 to ae+ure that qu¦hned perwnnel property Lather and evaluate IM fnfor.vtbn <br />mbmltlyd. Eased on my Inquiry of the penoel or persons who manage the fy,lrm, <br />-? <br />' or those penoly direrlly re,Ponalbk for gathering the Infornullon <br />the Informati <br /> <br />1 <br />,, <br />. , <br />on <br />mbmflted I <br />f m <br />to th <br />b <br />t <br />tn <br />l <br />•.,i <br />_ <br />7C y <br />& <br />e <br />e <br />o <br />ow <br />atlp and belief. Iron. attvratr, and rompktr. y J{J / / n ii <br /> I ...ware that there are slgrolkant ptnaitle for aubmrtt)ng fahe Infonertlen. 41ONATURE OF PRINCWAL EXECUTIVE <br />V <br />TYPED OR PRINTED <br />A.I r1C a a1V \/1111 Inrfuding the poselbluty of Am and Imprhonmrnt for knowing .Wsuon% <br />• Ttr\¦.? OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />I-VMmCre 1 J P%FVU Cnrr-tile ll r lvl, v. ..... .aver, I IvreJ F-arr.n(:I wr .era4nn s,n(J nI/If <br />`4HR PRF-CIP EVENT IS CLAIMED. IF CLAIM, APPR0'%-/Ew DY <br />r_ 1 .. , -r? E:! F I <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used <br />+r' :I 4 c1. 'Th(St!0l'f3-W lQftn. PAGE OF