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PERMITTEE NAME/ADDRESS p-r&& FwMryN-?L-.iian f/D(A-i) <br />NAME <br />ADDRESS <br />?I ER <br />FACILITY JWYO PI I NF <br />LOCATION i?ER <br />-_LY D. SANDFnS, <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDES/ <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />Y AR MO DAY YEAR 11 M DAY . <br />FROM TO <br />Form Approved <br />I N U P OMB No 2040-0004 <br />SVB? _ . <br />F I NAL mciFr <br />J =ST PIT 5E:? POND TO AYL©Fc CH, <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FRE U NCY SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br />i <br />' <br /> <br />- <br />SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT :30L A ....; DA ! t v ('f X <br /> SAMPLE <br />MEASUREMENT <br /> PE <br /> RMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PE <br />IT <br /> RM <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> P <br /> ERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMI <br /> T <br />REOUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTNE OFFICER I certify under Pen. q o I-- that tAb document and an attachments were <br />pmpered under my direction w wpervlwon in .rrord-nee with . s"Ieen deigned-` - - /? - _ % _ - TELEPHONE <br />to <br />am th <br />t <br />ualtfl <br />A <br />' <br /> <br />DATE <br /> <br />-f ?? ?' ?•?'r J ? <br /> <br /> <br />'?- :'v <br />C <br />• L <br />?'?t L <br />L <br />?1 >`Ir a <br />a <br />a <br />ed pemonn <br />properly tat Mr and rraluate the Inforuutlon <br />robnitted. Dowd on me Irpulry d the person nr pemors who manage the ryflrm• <br />or those prrxxo directly responsible for gafherlnrg the Information. the Information <br />wbmllfed b <br />to th <br />t of m <br />b <br />k <br />wl <br />d <br />.,?• li <br /> <br /> <br />J <br />•t <br />i <br /> <br /> <br /> <br />/ <br />; <br />r <br />-- i <br />i <br />/ <br />? <br />• , <br />e <br />e <br />y <br />no <br />e <br />ge and bete(. Irve, arcuate. and mmPiet <br />I am -ware that them are sfgniflunt Penalties for sabmlfttng Ww Information, <br />SIGNATURE OF PRINCIPAL EXECUTIVE _? <br />/ <br />/[/ ( i. <br />c /:_, <br />" <br />TYPED OR PRINTED <br />r-nl,ALACKITC Ahlr% FYPI ANATIAN f)F ANY Vint Including fM Feasibility of fine and Imprisonment roe knowing violations, <br />ATIntuC -ar OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />TLEABLF SOLIDS LIMIT APPLIES ONLY IF <br />- 4HR PRECIi' EVENT IS CLAIt?fED. IF CLAIM APPROVED <br />T?`I:M t TT^` Wtil r 1 rFl -- T M;:: SEE 111 2", ''71 <br />STRUC <br />EPA Form 3320-1 (Rev 3:99) Previous editions may be used ?iQ 4° T 7b iS 4-?1Tt`form PAGE OF