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I I ? ?o Form Approved. <br />L <br />? <br />PfRMRTEE NAME/ADORESS (/wdrbFaedryNaw?Lxar/aw I1DIQi.wrq RE,?--, • <br />w_ NATI ONAL ?OILUTANT aSCHMOE ELIMINATION SYSTEM (NPOESI <br />HARG <br />MONITORI <br />G REPORT (DMR OMB No 204a?4 <br />NAME DISC <br />E <br />N <br />) <br />ADDRESS 'Ja ^ _ ?i t? PERMIT NUMBER F,?.AIGE NUMBER <br /> <br /> MONITORING PERIOD <br />FACILITY Using and Safety MO DAY <br />MO D <br />Y Y <br /> YEAR <br />A <br />EAR <br />LOCATION FROM TO <br /> NOTE: Reed instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />AS <br />MENT <br />R <br /> ME <br />U <br />E <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I cenrty -&' Pe-.T1-y.-r-1.- that thb doeamrnl and ail atlachrrrmu wen TELEPHONE DATE <br />prepared under my direction or fuper,fdon In accordann with . sysleen designed <br />to aleun that qualified personnef props. y gatMr and evaluate the Information <br />submitted. eased on my Inquiry of the Person or persons who manste the system. <br />, <br />or those penom directly reaporedble for gathering the Information, the Information <br />i <br />L submitted Is. to the bet of my knowledge and belief, true, amurale. and compkle. <br />SIGNATURE OF PRINCIPAL EXECUTTVE <br />i <br />th <br />t th <br />i <br />ifi <br />t <br />lti <br />f <br />it <br />I <br />t _ <br />- am swan <br />em am s <br />gn <br />can <br />a <br />pena <br />or subm <br />ting faller <br />nforma <br />ion. <br />es <br />TYPED OR PRINTED Inr*dingthe possibility of nneand lmprf.orrmentFor knowing .Iol.tlorm OFFICER OR AUTHORIZED AGENT CODE ?MSER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference oil effechmenfs here) <br />EPA Form 3320-1 (Rev 3)99) Previous editions may be used This is a 4-part form.