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PERMTTTEE NAME/ADDRESSR_... FrfbpNr~lerm°u ypdG,wq <br />NAME ~ _ v '. : a ~ •~., <br />F'P.vY <br />ADDRESS" : - 1. • 1 { ; ;1'' . ~' p t. :: 7 N A h <br />'!S1 4C 'I7 <br />- ~7 .~.. r;. 7 <br />FAaLm <br />LOCATION ~ L . <br />NATIONM ppLLVfANT DISCNARDE ELIMMATQN'K>nEM (NPOESI <br />DISCHARGE MONITORING REPORT (O RI <br />t ,. 1 I; <br />,• .. (FGi3k ,: C) <br />+PERMIT NUMBER ~ gSCNMOE NuM[fR F - f : '+ A'. ~ F:` D T'i <br />MONITORING PERIOD ' M A ~'~ ' F r~ ! D ~ I. !' t r. ~ Y <br />YEAR MO DAY YEAR MO DAY ~'~ -- <br />FROM ^.( ~~ O~ .TO 31 K .i. l..y'•;~ ~__) "$4 <br />R~~d IEwVUetlar bda~ eompl~tMp th4 lam. <br />PARAMETER QUANTITY OR LOADING <br />Quality or Co <br />ntration ~ NO. FRFOVENCY SAMPLE <br /> nce <br />EX of <br />TYPE <br /> ANUrzs <br /> AVERAGE MAXIMUM MINIMUM AVERAGE MAXIM UNITS <br />~I;.: ~, .'-IPGI:P:~i. .. 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E~1~'1 <br /> MEASUREMENT A NA 1Jn 1~~4 <br />1 ~ ~ :•::.:: PERM .. .. . <br /> <br />RE <br />U <br />ENT : ... ... .:.: ,-,.. :.. <br /> <br />.. ,~~.: <br />.... <br />. <br />: <br />: <br />: ..s a:a. <br /> <br />,. <br />':. <br /> <br />:. <br /> <br />s <br /> <br />,,'~ <br />:: <br />~. :, _ _ ,-,. : <br />Q <br />IREM : .. <br />:..: .: <br />:::: . <br />. as:., . <br />. <br />.... <br />POT 61. <br />~ SAMPLE -< ryq...; ~ ~ I.1 <br />{ ~ <br />~ <br />v <br />~ MEASUREMENT f .i ~ ~ % f : p r~ _ <br />:. l + ~ 1 0 ;};:j :PERMIT. ~. ~ ~ : ~ ~ :~.;; gp:4.~1 i,Ss; "ems.?.JOrrix'reir :P: ~: ~ ~ <br />~` r,.. .. .. .I;. ,. ~; ~ r~..~.T~:.~; <br />, ° :~, ~r .j, Y 1 y A ~, <br />r : I ...:. _ -. - , . 'REQUIREMENT ~.. <br />; r. <br />~ <br />. <br /> <br />.. <br /> <br /> <br />. <br /> <br /> <br />, <br />" <br />r~L'.. I', I')KDII IT IF SAMPLE q ( 1 ~~ a;~: :: r <br />.~ I~/ l <br />~ <br />! <br />r.. ~ r ;':"°'N7 NLG ,_ MEASUREMENT I.I'{ ~L~~D ~' IDT ~ / iN,• <br />A <br />. <br />,. fi J ':PERINIT'::: ~.•: ^n:':rT : $:Fr•,.;;r. <br />.x'>` .. ,.. ,:Ct"-<.'=-r.: ._ ~:; ;:FKLY ".4". <br />.. ~ I ; ' t' .~ H D S 5 V ? L. ;) , REQUIREMENT :- . <br />. <br />~ ~ ~ ` ~ ; <br />: F.. <br />~ <br />,. ~ .. . <br /> <br /> <br />~~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1Q""r ' 'rp'""r°'. Innr rM1 b Eavlnenl nne nNnllrcn~na writ TELEPH D <br /> <br />prepurM <br />ubrr mF Glrrcll°n°r.uw <br />r•nion In urmrdun,e .IIM1• <br />rrem artl <br />~,ed <br />.. ONE ATE <br />R i e ha rd M i 115 g <br />[ <br />to mun In.l qutllpN pemnnd pmwd~.[nnrr.M arnlmre Ine Inrormulbn <br />w,bmn <br />2 <br />E <br />l <br />J <br />I <br />r <br />n , <br />~ <br />_ e <br />. <br />s <br />en ml <br />~pu <br />rT ° <br />I <br />r pMn a prrbv wn° nunnp IM.PIem. ' ,/ - <br />. ,~% ~ <br />Environmental Manager or lAue paam tllncllp mpuiMbk fwplneAn[I~e lnromunenJnr lnr°mutl°n ~~~-~"~ (` ~ /// <br />- p p-/ <br />Q <br /> aubmlud 1; b IM1e Enr °l mr km.ktlR na prllrr, Irvr, rttenle, rnE mmplrle. <br />lum r.un lnul lhrre ne A <br />nlnrunl <br />n <br />lll <br />f <br />m <br />n <br />M1 <br />I <br />t10NATURE OF P <br />I <br />E T C II 7 ~- G / 1.. ;::'r `% ': <br /> <br />TYPED OR PRINTED w <br />r <br />s <br />°r rvb <br />i <br />n[ <br />[ <br />M <br />"furmulbn. <br />I~naln[Inr pmaElllry°rnM.Mlmpnaonmem rorlm.ln[.l°luunln R <br />NCIPAL <br />%ECUTNE <br />OFFlCER OR AUTHORIZED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> <br />r^~:,T "!" "'1 vi 1•r <br />T^. R <br />~]"' <br />.- T'rL: <br />S'L <br />f <_ ,7_Y "'- <br />"i?' <br />- Y~,.' i5 <br /> .. <br />. . <br />. <br />. <br />.. :. <br />. <br />~..4: "`_' .. .= l.f,.4r r~: '.~ :Or !i!,n' 7 ",: '~:.:,'i• ~ `.I ,.. ,y. T't.. ~?L ~ .-- ,°:" T...1. ~. ~~. 1~1. <br />EPA Fam 3320-1 (R~ 3/99) Previous editions may be used. ~ <br />9'? 'r 11 / D~hi~~ i14 ~~ry(q~' ' PnQE OF <br />2 <br />