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PERMfTTEE NAMFJADDRESS P•'A`+I RIVAryNr'lxmlwl l/DleGrwa) <br />NAME ~_ .., .: a. .. '~L .~~... .:~'L <br />ADDRESS L F. ?. • °: r 0 <br />r:.Y~cd C.i ~,~r,jl <br />-FAaLrrv <br />LocwTIDNH A Y D E~ L:i u l! .i ~~ <br />4T PN: }..L II 4='.';. `; I;F i. s'Rii. vA4A '+'F <br />NArIONDISCFIAROE oMONITORINO AREPORT ~OMR ~ESI <br />rnnrnn~,r} ..tn <br />PERMIT NUMBER p3CNN10ENW{E11 <br />MONITORING PERIOD <br />YEAR MO .DAY ~ ~ YEAR MO DAY <br />FROM n 0 ;~' ,~ 01 TD ~ r 1 1 <br />r~•, <br />c 'E <br />_:. J. <br />(~u.,.. r.ir} ~1 <br />\~Ui'r. .iE; Tf ~TLNG ~`FOyyk Ol4P <br />NOTE: R{{d knWCtlerr Mta{~eompNtfnp 1hN fam. <br />PARAMETER QUANTITY OR LOADING QUailty Or Concentration NO• rRE° <br />FENCr SAMPLE <br /> o <br /> E% ANarms TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS <br />~.. '!U J: n'a[: 4Cr.n +C~_ SAMPLE .-.,t:'<:: nTrGiOR :. ,. ., ( )j) <br />f! I ~: a i'ri ti I p MEASUREMENT <br /> <br />.'~`,j C' I I) U PERMIT ~ ~ ~ <br />~.. .. ... ~..: ~ _ <br />~ai:.~J:`,:.r.: <br />..'~..~'.: %`<..::{.^ { <br />RQyy <br />,Ilyii rr.Li:4•J.::' <br />Y <br />.. <br />- <br /> <br />.,.L y. <br /> <br />.€rLUr:;•r „tin~= vAl.u• gEDUIREMENT <br />.:.: ......: . :: <br />. <br />~-xalx • <br />r~Ir.''~a1Ti=f: <br />r <br /> SAMPLE ~' <br /> MEASUREMENT <br /> .PERMIT. <br /> <br />.REQUIREMENT. <br />~ <br />.. ~ <br />..... <br />.:... ~:: :... .. <br />~. .... <br /> SAMPLE <br /> MEASUREMENT <br /> ~~~~~.PERMIT.~.. ~ ~. <br />~ <br />~ ... <br />~ . <br />... .. ... ;~.;~.:: :.. ......: .. . <br />.. <br /> ~REQUIREMENi ~~ ~ ~~ <br />~ ~ <br />~~ ~ ~ <br /> SAMPLE <br /> MEASUREMENT <br /> :: ~ .:. PERMIT.:. <br />. <br />: ... . <br />.. <br /> <br />.. <br /> .REQUIREMENT. . <br />~: ,~ <br />~~ ~ ~ ~ <br />.. ""~ ~~ ~~ <br />;. vw~::~.i ~.. .. <br />.. .. .. ... <br />...: <br />~:~:.. <br /> SAMPLE • <br /> MEASUREMENT <br /> ~::::: ~. PERMIT .. .. ... .:.. <br />:: .: :. . . <br /> <br />a~clilaErHENT ,. <br />.... ..:........ <br />. <br />:..:. <br /> <br />- :.:. <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT .::~. .:. ~ .... .. .. ~:. .. .... <br /> R¢auIHEMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ERMIT ~... ~ ...: .:: ~ ~ ~ .. . .. <br />. . . <br />:~ <br />~ <br />~ <br /> REQUIREMENT ~ ~. ~. : <br />.. ~..: <br />~ . ~. <br />....~. <br />. <br />~~ ~~ ~ ~~ ^ ~~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFlCER ' "~" r ° • p•""~ 0 1i"'"•' m e a°""'•"' •"a •A •"•`""`"ry w°^ ' TELEPH AT <br /> <br />prtpnlra w:wlrr mr alrtrl4n nr alp< <br />nHan In ac°la.nrt.lln .. <br />r4m ara <br />a <br /> <br />/ ONE E <br />D <br /> l <br />Enr <br />b mart Inrl qunllnN prnrnM prgrdl E•IMr rM oWntr IAe Inlwmrlbn <br />_~ <br />I 1 <br /> Obmlllyd. tlsd m m! I:p°Irr ar Inr Anon w pnwu wno :I:nnye IM ryrlr:n, .~//'~ <br />r <br />1 . <br /> or Ihse pr.em tll~lr rvpn:lank ra Enlnrrlnq Ibr Inromutlnn. Ilse Inf°rnuawn ~ <br />(1 (~ ~ <br />`_ <br /> dbmlllyd 4, w Ine nm °r ml Ynnw4ap nna Mtlrr. Ine,.min4, rM a"mp41e. <br />I.m..nrtu.l mrrt"rta <br />llnnm <br />dtl <br />r <br />n <br />w - / ~ I U ~5 <br /> p <br />pm <br />n <br />or n <br />: <br />lanE nM mrorm.uww. HONATURE OF MIEICRAL E%ECIJTIVE <br />TYPED OR PRINTED IMWInEIM p°aannlry or nwr.m lmprlaonmenl ror b:mwlnE .Id.tlols OFFlCER OR AUTHORIZED AGENT CO E NUMBER YEAR MO DAV <br />....,.... ... ..........-.. -. ..... ..-...,...,.., rr....r vn.. wr wu.l.nmmla n.rq <br />,,r FP.':T L.n.l+ CJi :..,'diL: ~r' _P:~i .:):._.,;~_ E: .',-~ LCdh;~T DILUTL'J;i (, :FrL'J:.'~) ,.-.:.{ .. LLTi~FL T% , <br />'F TL~'f ,"'i~ARI:i.S~ (:,CS:) :,Ili, d~.,',C:1 AC'J':" T^.'<I:;ITY i.`.;I r!cF'Ot?'I FOh:'7 "'U L`.,. <br />EPA Fam 3720-1 (j~v 3/99) Previous editions may be used. ~ This is a 4-pan form. PAGE OF <br />.. _. _ _ _ _ _ _ _~,.~_._.. 00067/ODU'r1!-~ol~ 1 ~ <br />