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PERMITTEE NAME/ADDRESSQneiL F~YbryNr'(arnuan /Dlsnr.np NAME .~1i, .. a:i'l Y=.N, P C'~.e,L ^~•.; •.; , ADDRESS" [ h : .~ 1 , .~, r • .I . , '. , .. ;~ i " i D , 1'1ti1`, ~t~!> F11 'JAM _ .`r' '_~ y:,q-.? FACam LOCATIONjn:. .~'•,.rY li(/4F,] NATIOMILL vOLLVTANT OISCNMOE ELIMINATION SYBTDA ((NPDfSI DISCHARGE MONITORINO REPORT /DA}Rl ~ 1 r. /,: a r• lC) PERMIT NUMBER dxHAAOE NUMem _ ~ c~ { N AL MONITORING PERIOD I'+ :: 1 , P ~ N p c T n _ ; ,: YEAR MO DAY. YEAR MO DAY __ EROM ~.i 9 TO ~I )~ aea ~ DI°^4a~.::.' ~__~ :,. ,,. ' is f~*.'~ Rnd ImtrueNar bdar~ eemPltlhq Thb lorm. PARAMETER QUANTITY OR LOAD - _~ puality or Conce ation NO• FAEDUENCr SAMPLE AVERAGE MAXIMUM TS MINIMUM AVERAGE MAXIMUM UNITS EX of 'V'1'uT~s TYPE .. ;nV, ".IT4L SAMPLE MEASUREMENT .. .. r ..l .`~~~ ~'j ~ I O ~ / I~ ~ ) ~ , / ~ S ,, ,- F. ~ I f . ( ,~(~ + r q L IlJ'I'. 1 '.' ..: :':PERMIT...•:.:.:: ~:.u~:xi,~tite.k~. ~~. .. . .. . :~~~-x ;; .a:±ri.~..,. . ~ ~~ ... yt~:44.4gY`:'~.? ;:<: gt : ~. ~: .. ::..:::. :~ ~.. :::.: ~:u;y zs 7..~.Q~:~ i.~~ '•:::'::~~ ~3' ~ L ,. ~ . r,..r.~ ~. .. . , I . '.f F't. ,I~~I ..d.7~~ VAL I. ;REQUIREMENT.. .: ...: ::. . :., . ~~~ : . .:. .:~;.~ .. ,, ~,. . .. 'i. n';;~ :4 EASE SAMPLE MEASUREMENT t,cxrc^ n^nr:~~. "Pv C4LeP .. ~~ ~ il ./ ~ ~~~ VI~ a l /V N~ I IV '71:: [?2 1 7 J ~::~ .PERMIT' ~~~ ~ n::w ^:t •, ,~'k.Ft~AV: ~ ~ ~ u:; `,+li61 dt S'. ~ , ~; :: ~ ::•r . ~ ~ .IMF , 'F'?LU-:~.i';4055 VALUt REQUIREMENT ~:;.. .. .. .. .. ~ ~~'~ ,::...:,:.~ ~: .ar:o :.,.:~<:::. ~ ~, .~..~.. ~ :,;T... Y. L .. ~/ ,, .. . ~.i•'..•7: : :. .J~, i M ::JYC'J;'1 'J F' • ' SAMPLE MEASUREMENT CC ~ (~ `v~ ~~ ~ ~ Fl71 link Ut((h,. exOhr. .. .. ...+ .~ f~` L / r .r : ! ~ ~ r. v ...., ' ; i L c " •• • U. ti~~ Y 7 1 r IS {!I ~'JJ?t' ~ C ,i ::~':;.:PERMIT:..~:'r: .::~~:£F :.:' .t)'F= F .. :~,.''7'f~" ~ ~ ~ .~;.CtK.,;:.?i~d'~:•x~ '~"~Y,t:q~#iOfh:A~:... ~ ~:.::.~:7~~~ .: ~~ !(Z:Y~~ 1- n+ c ~ ~ : .. ,7 ..; • .' ., hl.J...,I ~~R.~. VALL' . :REQUIREMENT:: :.::.:....::..::............. . .. . ~:~ ~.C~ .:.. :....:. ~ . .:~~: .,.,~.,.:i 3.V.F.A A.Y. . ~~:~.:•..r,~y:.yy. ~ ,..... .,.:.. ~i::.:'~`~ ~~~':1:; ~.: ; .x ... ....:... .>~.:-~':~; : :..:....:.:>.;::::. .;. .:. . _,:.:.. .. .,, ,. . ,... . _ "'LIJ`i, ?"':Ai. ' ' SAMPLE MEASUREMENT r.:4rtr10^ rr/.:([q.;.. ~~..,:.y+ ~ 272I / ~ 2 q ( ~ .) ~ ~ (? / CI b 6 :. i i L'J . I ~ r ~ ~ I /'.': a•, 1 J '1 .'.~:~`;PERMIT::... :. ~~:.a+~?A.;4<x~#.:': :::':#3~?n4 r,~w ~ ~ ..::.. ~~(''L~(::~:: ::fi ~%i?1'::.:.:.. :';: ~:NJS ~ :~;:'::~i:.>.. :. F%rz:u:~T~.." :, ^~:~vC:~+ '~• 'I;h :,. . ~,. _ .1 - - ~~c I c .,.FLLt. 1 .,hJ..., lALU .REQUIREMENT. .:....: ,:~... :..... .....: ... ~ ~ .::. : :. ^.~.~• x. .<.~r 1: ~~ .;.:: :: : : :~+~ xY IFi<~f:,: .`.~:'.YI?':`fA~L: ;•~/i. ~ 7~ '. >I ;' ,I~hAS:: SAMPLE MEASUREMENT La J. ~• ~ 1 ~ .J '+GRIf R7hRen .-: rl •. !n' r ~..;Uo!~ S J U .. :'~:;PERMIT;':`.'::'~ ;:<.•rr~#y?fi~.a.a-:~. ...: .. . ;::..:~ry,~.: ~_,. ~... ... ... :., .v r..::w ., ,.... ., ~. a?~:~." . .. . .... .: ... ~ ';~I:#'~~yF;[it:~,~::: ,;.?^~k~?.:;:Se..#~I~;#.~i:~ ~.t^-. Ia.;:I7AL .; A., .. ...,~ ~ F.. tLJ I .:._.5 VAL If . :REQUIREMENT: • :.::..: .: :.... .. . ... ~.•.: ~::~::.~.. ...: i '' ::':'. ... ~....:...,:..::.:, .:':. ~T... o.., :. l.' . :k,`+e•, SAMPLE MEASUREMENT :~::~:.~ PERMIT:.: ~ :. ~.: ~.~.. ~..::: ::. .:...... ...... ..::. :.:.: ~ ... ... .... .. .. SAMPLE MEASUREMENT :: , .~:: :... . : REQUIREMENT' : : ;.:. .... ~ :.::. ~::.::.... , . ..: :,:I NAME/TITLE PRINCIPAL EXECUTIVE OFFICER "`^'IT° r'prna>el.. ma ul. tlaumrm .na .b.u.rbll.n~..rt prtp.M nMrr mT elrtnnen er wprnl~en a nam t.nrt .Iln .,Tartu edrnd TELEPHONE DATE I C l ~ r. /4 /11 i 11 S to nmert+bnl qunllnN pernnna „epeaT plMr nntl onlutle Ine Inlarmnlbn , Nbmllld. bmd en m(InqulrT Nlbe prbn er prrvv.bo mnnnp lM,Taem, M1 /~ , /~ " 1A /V!I//t ~/ ~°' /• L IV er I D•r Rry.u tllrtcllf lvpedbh(q(.IberlnF Uelnferm.llm,lbe ln(erm.llon bM dl b , -! ~~ ~JU t-~l ~ ! fJl / n ll ,,lel rbflofm(btu.YtlpeMbrbrLlrve,rrvnle.nrMnmplrle. I em om Nul Ibrn un a lll l m ~:~ /,~ ~ ~ bn nn penu e fer nbmluln{ hbe brorv+.uo., t10NATURE OF -IIINCMAI EXECU77Vf TYPED OR PRINTED In,lnaleq lb. pvdbIIIIT Or n,..na lmvaenmr.l r>bm.InF Nw.ueb OFFICER OR AUTHORIZED AOENi CODE NUMBER YEAR MO DAY .................., .................... -. ..... ....... , ..,,... n,.,oo,c. m .u~cnm.nra n.r~/ :,i~rJATi. LI cI', P•: :'i}, IF0;1 t'r ;R^?LEANL° .'.7L7r9 (L'1~ "'~) i. F.^LY ..': L'f T. F~ :_ ?_-Y N, 2rl_p~{ "rR ~C;II' cV !•,t '' L- -LA T"Y". :, c~ I.A.4 i': N F'OR 5URL'P.F 7f Du~"1P 7>0 •;I yc•.cq~•:~e ~u^ c c!T mr• T: c ~, EPA F«m 3320.1 ~. 3/99) Previous editions may be used. This i 4, an (' rm. ~ PAGE ~oF ol~~zaL/o~L,3~~-P.~Y .. .,, ,. _.,.._ :_ . _.a~ ..... .. ..