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PERMRYEE NAME/ADDRESS pwrY4laNryNr'L«.na. /DrOirwtl NAME _ ;L"i. =. 0!1 .r h'" A ('S!. .')M I" ADDRESS'!: P1: 1.~' 1 ~, r.~''h.'. FACam .I`ve, L ~., ~.~ is .,^ -_ vl yr. M, NATIONAL pOLLUTMT OISCHMOF ELIMINATION SY4TEM //NPOESI DISCHARGE MONITORING REPOIIT (OMRI PERMIT,NUMBER axNMOENUMew MONITORING P D YEAR MO DAY YEAR MO DAV FROM ~ 1 0 ~ Q ~TO 'i 1 ~ '-) - °I•~A' ~ ~~..:. : :, FOND !+ ?O F'~I:~°L •~'r'" ' NOTE: Rnq I~dorr beion compbtlnp thb loan. PARAMETER QUANTITY OR LOADING • puality or Concentration NO. FREOOENCr SAMPLE OF AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX µKY9e TYPE ~:ILV''H, f~"~*3.NrI+LLY SAMPLE MEASUREMENT ..:=uOhR n~:errt^ r,r~Y:kh OO / ~ 6 ~ O . O d, ( 1'9!'. Z G , (i L :~ ~) L V ::.) , ~~ J I .i 7': 1 J p ~~~:~~'~~PERMIT.:;.::: ~~i~ix 3oyr4cRa. ~:~ ~?. ..rt ;r ieRy'i~~9~~ c ~ :;~~w~rr:~ 0.E ~ .:.: ~ M ~' . ~~3 ~ ~ ~ ~~A F~~~::~:r:~ ~ ^ fir:^`:7 ~r :c ;. 'FP1J1"•I'" ;li"•"i V :~ c _ _ AI. 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THnr.an u.lnrnrm.nen. mr mrnmrnpn ~~; /~ ~ .- ~./~.'^ , ~1~ ~$^/Q ^~1/ o ~ I ,IVI hr , a i• , T ' I q V ~ wETII1N4 aloe 4er of mTkM.ktl Hrltl !excl. lrvw.[tvnle,.nd nm Ile e , lI / L+ O ,~ , ' I em ven u.r Inen nn p Mennl ntlnn roe rvD tum nl dr l 810NATURE OF -RINCRAL EXEC 7T I ~ E g ln E . ornol en, IM tlI n nl tl I NE TYPED OR PR NTED U nL l e p.. e y nrnl..ne lmpnnnmrm rn. M1lw.lnE.lW.ums OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY ..vmmcnrJ nnv cnr Lnnn,wn yr r.n, •.vLn rlvnJ Inglrlncl Mlrrlcnm/nlJ nlrl/ ..:"riti.l- Lr:I,•, :~;r -., ;"^I'L."ANL° SJL[! (Lr~ .".,,I :H'.LY "•±Y :Y •._ ..-,"'~~:1-.r .: PdPC7P EYS?T LAI... :c:c :A:i'' 7.6.7., .... i °pn ['JRf,Ph JP Pa ):,i' F'"jUTPr.~cyTJe _1IL E ;:•re1°,., - ~=: F' *.nw1.D, PG. 11. EPA Form Ja20.1 ~' 3/99) Previous editions may be used. ~ n 1 ~ ~ / .~'~I~s~is~ ~ 4 ~~r}wrm. ; PAGE ~ F