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~ i ee rvAMt/AUUHESS (/ncfudaFac[!iry Nmrullotatian if A'ffera4t)
<br />NAME
<br />ADDRESS ; - A ,, o •- n •`) p,
<br />o,~. =1:. 1^7
<br />FACILITY '. ^ i ~ I " - - _...
<br />LOCATION
<br />NATIONAL POLLUfANf DISCHARGE ELIMINATION SYSTEM MFDES) FOrtn ApprOVed.
<br />OISCHARGE MONITORING REPORT (OMR) OMB No. 2040-0004
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<br />
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<br /> PERMIT NUMBER DISCHARGE NUMBER _ r ,_
<br /> MONITORING PERIOD ') •- I' `'~~~ "-~ .;il10T; ~UL~?i
<br /> YEAR MO DAY YEAR MO DAY
<br />FROM ~ 'v TO a ~,,, :{,; 1~i :+i ., ~_ l:"-~;r ~~ ~"'R
<br /> NOTE: Read Instructions beloR cbmpleting this loan.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FgEOUENC SAMPLE
<br /> EX of TYPE
<br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,WAt>5/s
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<br />NAMEIrriLE PRINCIPAL EXECUTIVE OFFICEq ICeniN untler penalty of law that this tlocument antl ell abatltmerns ware TELEPHONE DATE
<br /> prepatetl under my dnection or supeMSion in accordance with a system designed
<br /> b ssaure that qualified personnel properly gather antl erWuata the iMOnnebon /s
<br />'~ ~
<br />~,ordon Cetera
<br />? eubmlttetl. Baeetl an my Inquiry al the person or persona who manage We eystem. ~,
<br />~ ,~~---'-'~~
<br />. or ttwse pereons atecly responsible for geNaing the Inbnnegon, the lnfomution i' ? L)-S ~ 4 -440 ~ ill V 7 ! ~
<br />l'r~yidentJGenaral Manager submldedle,bthabestolaryknowletlgaendballel,INe,eecUrete,entlcomplete. gIGNATUREOFPRINCIPALEXECUTIVE
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<br />T I em ewxe Ural there ere slgnlRrare perollies br submitting lake infomiatlon, OFFICER OR AUTHORIZED AGENT
<br />NUMBER
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<br />TYPED OR PRIN
<br />ED InGUtlinc the opesibiliN Ol flrre end imprisonmern tar Mrrowinq violatlona. pppF E
<br />R MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rererence ell attachments here)
<br />> i:1T .. •. .. L: .i 1. watt. . r -l.`. .~ .i ~~(. .,-1. ... r. '.~',. ':.1 v. ...1 , ,'I'Li: 'i _".., ,'l'l.:ti't.l:-
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<br />EPA Form 9320-1 (REV'S/99) Previous a ikons may be u ~~ ~ - ~ ~ ' ~ ~ - ~ ~ ~' ~ ~ /l ` 7 ` ~ ." ~ ~~ I T.(-IIS IS.A4-PAkT FORFiI PAGE bR'~ .
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