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~r:r J4cro.~'. <br />FERMRTEE NAMFIADOREat II..F.A+.~nnx~1«w... uM? .~~ ...~:orl.i ra.~)rwr nsc~.nol r,,.,,,.„x x~.<ru ,:.~~:'e ~; caw8 rla. zOiO- <br />NAME DISCHARGE MONRORINO P.EVORT !QMn! ~ <br />s <br />ADOR(SS ~ r <br />.., . PERMIT NUMBER asGWlOI grAAIOi _ <br />FACIIm ~ ~ ~ ~ MONITORING PERIOD ~ ' <br />IOCATgN Y AR MO GAY YEAR MO OAY <br />..LG6Y ._u C... FROM TO <br />. ~ `~ v i 61:1. ... :, n , (; Q j • 1 a h AL; E r, NOTE: R••d In.wclio.r Mfor• •grpMNrp tlrl• loan. <br /> <br />PARAMETER QUANTITY OR IOADRJG QUALITY OR CONCENTRATION I/O• ~ p~ SAMPLE <br /> <br /> <br />AVERAGE <br />MAXIMUM <br />VNRS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX AMAtvaf TYPE <br /> SAMPLE <br />A <br />I <br /> ME <br />SUREMENT <br />.._ _ _ <br />~ PERMIT -..vt~~-.: _:,ns...~ 6•S -~ ~ ~.r r: 6'C[/ IcI.• <br />t <br />- REQUIREMENT <br />~ <br />ff tlU ~ <br />y i - ~r <br />l~h'i: <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAM?(E <br />MEASUREMENT --- -- - <br /> PERMIT <br />REQUIREMENT <br />!~ <br /> SAM%.E - <br /> MEASURf.MENT <br /> PERMIT <br />REQUIREMENT <br />- <br /> <br />--- <br /> SAMPLE - _--- <br /> MEASUREMENT <br />~ <br /> PERMi7 <br />REtlVIRFMENT - <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <br />~ <br /> <br />-~- <br /> SaIVtFLE <br />MEASUREMENT <br />..._ - <br />PERMIT <br />REQUIREMENT <br />.~ <br />NAMEJfITLl PRINCIPAL EXECUTIVE OfF1CER ,n'^')' ) ti=aw u,w sY.....r .., .. nr..w....m ..r. <br />TEIEPNONE <br />r..r....r ..d.. w r. <br />.w. <br />..., <br />ti <br />in <br />a <br /> <br />DAT <br />E <br />. <br />r r~ <br />s. <br />w. m <br />. <br />..)w«. <br />•.r•M <br />b tw.n u.r NdM, ~.^r'..1 rA.ri) f.Y.r .w....Mµ. Hw I..ra.YUM `-_ <br />~l.tin.a •ra ... w) •+S.aT e! A. M>e. a r.no.• .M srw..r Ae .P)rw <br />. <br />r•.iirr <br />• w b rM . <br />r r., <br />. <br />..r• <br />• r. <br />v <br />. <br />. <br />t..o <br />w <br />. <br />. <br />...........N....a m..~Nr.. / <br />Irr...n uxr..nv.•.wnar p..•+n nr ..f,nn.y lr~bb.m.o•r, •IONATVRE OF M1NpfAl E%(CIfTNt .~ <br />TYPED OR PRAfTED r..+.an~w..rwyNn~..rr.yn.,...,,n r,,, ~,.,.).~..y.ow. OFF1C(q OR AVTHORr1FD AOtNT A NVMBEq YEAR MO DAY <br />(:DMMCrr r a nnv cnrannn r.vn v. ..~.. ....a....vnu mow•nw •, m•c rm•nn nwq <br />CPA Form 3320-t lRr. 3~ssl aw~a.+w~mn. )rr•yn. ~+w ; Tttis isa ~(_ pan form. PAGE pF <br />