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PERN¢TIEE NAMFIAODRESS Rwe4lerwryNr't+r.nw yU~ wr) <br />NAME <br />AWRE55 _ .. <br />t0~ 6db <br />CD <br />fACILm ]9I20N 1IYY, <br />lOGT10N CJ <br />ev^s oan.o MT NP NENaC <br />wAnONAI IOIIVFAwf OIXIIAROE fiIMWATW sv9TDA /NPDES) <br />DISCHARGE MONRORWO REPORT lD R! <br />PERMIT NUMBER gaCNAlIpL wUMbU <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO AY <br />FROM 70 <br />form Approved <br />OMB '~w :CWO400a <br />(3J~IK T:1) <br />c _ cjyA~ <br />NOTE: Mad MNUCNona balor~ compMdny dJa form. <br />PARAMETER QUAMITV OR LOADING QUALITY OR CONCENTRATION NO. <br />E% n(covfwcr <br />. SAMPLE <br />TYPE <br /> AVERAGE MAXIMVM UNITS MINIMUM AVERAGE MA%IMUM UNITS µf,(I <br />ys <br /> SAMPLE <br />MEASVREMENT <br />t ~~ <br /> REQUIREMENT __ <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />_ <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASIREMENT <br /> PERMIT <br />REQUIREMENT <br />___ <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMt7 <br />REQUIREMENT <br /> <br />_ _.~ <br />PRINCIPAL EXECUTIVE OFFICER <br />NAMERITLE rwl.. , w.•I; .: +6:~a <br />. el...rw <br />., w <br />. <br />. <br />e . <br />e.r a: ~n[u~wl x.n x<.ae <br />...lrow Iw <br /><wdxae -Ile wa..x. <br />. I..Iwn s.e(e.e TEIEPNON E GATE <br /> P <br />r <br />p <br />n <br />w <br />A <br />e <br />a <br />M l~.n Tx N.eMd pe.fonM ~rnfrl) (xMr ..M rWxr Ik Iwferwxb <br />weeerl(a DaeE aw w~> Iwo,+r e( rwe prsw nr Y*+.e+.e0 nw.(e vw .)rlal. <br />nr I71(N p•ww almf+. nrye.eleM IK {xkrt.y Ik INeITIIIM, 14lwfnrnseen _ - <br /> <br />- _ - <br /> <br />- <br /> <br />. <br />_ wM1111rfe L. 10 V.f MI of wJ lwlw46ff .M Maef. Inf, xNnle..ne rnTpYM <br />a10NATUliE Of IRINCI-AI EXECUTIVE - <br /> lunl.ln ax le.,..ne(Illn...+f.w.al., rcr wew.niwa rxw brnr.~eea A <br />MBER <br />V <br />TYPED OR PRINTED IwrA.emale.F.remlr nfnw.ee liwpbewwwl r..lew.lq .bt.lbev. OFFICER OR AUTHORIZED AQENT CODf NU YEAR MO DA <br />COMMENTS AND E%PLANATION OF ANT VIVLA nVNS (RHafanca AR ~rrKnmmn naar <br />• -? ~ ,f <br />EPA form 3320-1 (Re+ 3~99)Pre~nove~Mmonc maY be used _-_~ _ - __ ..i i,l~ .. _. --f~..l r- lol:,.~ GnGE (~S_ <br />I ~~_ <br />