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PERMITTEE NAME/ADDRESS (Inri. FecihfylV.aau`L-.,ton (/D(ffireM) <br />NAME _. J <br />ADDRESS NE <br />57,31 uTATI. HICHWAY 13 <br />''IFEV_ER 0 <br />FACILITY . j]LCWYCI MY NE <br />LOCATION, It-EKER co <br />,C LLV D. SAND-F,95'. VP OF <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT W MR) <br />l_ - <br />PERMIT NUMBER DtSCHAAOE Nt1MEEA <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO _ DAY <br />? . FROM <br />3f 5 TO - <br />M"NO <br />Form Approved <br />OVS No 2040-0004 <br />NOTE: Read Irmtructiono befw• completing We form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION ND, FREOWNCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />AW) ^! ._f .. SAMPLE <br />:AJAL- MEASUREMENT <br />?f• O PERMIT k s `, L ?Y', cI=? j .. is u# ^*-T <br />LUF.^aT REQUIREMENT IfiX L ?C1 - 1 ?t## a '10NTt <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <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 />NAMEMnE PRINCIPAL EXECUTIVE OFFICER I mrtd) under Inn. by o low that thb document end .u ¦tLChmenta were TELEPHONE DATE <br /> prepared under my dlr-ilon or euper.lalon In accord ante with a system dettlgned <br />` I to annum that qualified Personnel Property ether and evaNale the Infor Ilon <br /> Dried on my In <br />uiry of the <br />mbmttted <br />e <br />o <br />h <br />t <br /> q <br />. <br />p <br />rson <br />r periem w <br />o manage <br />he ryrtrm, <br />/y <br />/? _ f <br />IJ` • <br />. or thour pervorn dlrtcllr ,tP6n 1bW for gathering the Information, the Inror lion <br />•' l ?- <br />? <br />/ <br />-- ' <br />, <br />r <br />( vu mlltrd K to the beet -(my Lrowiedte and belief. truv, in -W and aompkle. <br />I am aware that there are significant Penaittew for aabmftling ht: Inrormatlon <br />SIGNATURE OF /RINCI?Al EXECUTIVE <br />F t : <br />''r .. ;.? <br />TYPED OR PRINTED , <br />Ineluding the podblllte or fine and Imprisonment for knowing 0ol.ttoret OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Ur ANT VIOLA I IUNS I/rererence an errecnments here) <br />°R'=C1° 7*'.?=-N- TS r1.4,1MFn. :F CI /QTY AP?R(tW=13 r';' s`CD, <br />: T JS?tS-8 4-Pa€4 errn. PAGE Of <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used