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PERMITTEE NAMEIADDRESSn.mkyFrWryNw?L«sil+ ((D(06 t) <br />NAME <br />ADDRESS <br />?. ? f? F. r? '.. C1 8 <br />FACILITY 11)Wly0 ,'li F. <br />LOCATION _KLk CU E3 <br />.:LI-'t' 1-. SAND1 R'.>> Vc- Coi OP! <br />NATIONAL POLLUTANT OISCHAAGE ELIMINATION SYSTEM NPOES/ <br />DISCHARGE MONITORING REPORT (D R) ?, ;. Pd C! <br />PERMIT NUMBER MCHAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO D Y <br />FROM TO <br />NOTE: <br />Form Approved <br />OMB No 2040.0004 <br />befelra rnm.Lattinn thk frsrrn <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FRE OI NCY SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t- OF <br /> REQUIREMENT _- k A 1 L x I- X <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 /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE -- <br /> MEASUREMENT <br /> I <br /> PERM <br />T <br /> REQUIREMENT <br /> SAMPLE - - <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> F <br />IC p`..I" ^ Is. that Ih B document and <br />llattach w <br />e <br />t <br />F <br />NAME . TLE PRINCIPAL EXECIfTTVE O <br />ER si <br />m <br />n <br />s <br />ere <br />p"pand under n,y dlrrcllon or ms m In <br />Pr`'tef atcordaace with • system desigrteQf "? <br />I <br />h <br />l <br />- <br />•??.? <br />_ - /. <br />.- -- - <br />/'? <br />TELEPHONE <br /> <br />DATE <br />^ e aaun t <br />at qual <br />aed personnel Property Seth" and a-l elr the Inlermalbn - <br />l/ <br /> submlllyd. Saud on my Inquiry of the person or person, who manage the system, <br />! <br />- <br />j or those persore direetlerespo redb r fa gathering the Inform atloo. the Inroratien <br /> <br />submllled Is <br />t <br />th <br />b <br />:?'`? <br />?? <br />7/sc <br />r'-_ •• J <br />; <br />L'- <br />/ <br />1 <br /> , <br />o <br />e <br />est nt my ?newledge and WHO, Irue, wecursle, and complete. <br />1 / % <br /> am -wan that them are slgMfkant penalties for submt!nng tabs, Inrormatlon, SIGNATURE OF PRINCIPAL EXECUTIVE i <br />TYPED OR PRINTED Ir'-"a^t tAe fpalbllilr .(A- and ImpASpnmrnl for knowing .fWatlesn OFFICER OR AUTHORIZED AGENT NUM9fR YEAR MO DAY <br />n naaa .ra.t.. ern rvot ALI ATInu AC AWV VIlyl ATInfJC 10-i____ . CODE <br />...,........_LI F... _...-'.'i lD a L . l PPi-LIFS. HR F`RF!'TP E=V l`.!i ?S CLAIMED. 1F' CI_.Ail^ II?,^}.rV n rY <br />Wi- <br />;t tr ?, <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used TIUS IS'a A.•paEr=fpfnn. PAGE OF