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PERMrITEE NAME/ADDRESS pwdiirNONr'lxalar yOb..wp <br />NAME .- ~ r . <br />ADDRESS ' <br />I <br />FAaLm <br />LOCATgN <br />NATIONAL POLLUTANT dSCHMOE ELIMINATION 51'8TEM //NPOfSI <br />DISCHARGE MONITORING REPORT (OAIRI <br />PERMITNUMBER dseNMOENUAeER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM - TO <br />I~ I <br />NOTE: R~Ad Instructlorr b~for eompMllrlp IhM loan. <br /> <br />PARAMETER QUANTITY OR LOADING <br />Quality Or Concentration NO. pREOUENCr <br />op SAMPLE <br /> EX ALrss TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS M <br /> SAMPLE j <br /> MEASUREMENT <br /> :: PERMIT ~.:: <br />:: ..:;,,.'.~.-,~ <br />,,, ~.:. .. ';~ <br />L:; <br />. ,ar•.~ :~'?~: - .,;:f . <br /> R.EPUIREMEN7. .:: .. , .1 .;: <br /> SAMPLE - - ~ ~ ~ ~ ~ ~ I ' ) <br /> MEASUREMENT <br />,, PERMIT... ;-. ;: <br />ct <br />;:.^. ~::; .'>•:F : ,,.G . U ii.91 . _ c • , <br />r ~ ,REQUIRE.MENT ~ ~ ~' ~ :.. 1~ ~~ . y • ,j:';. <br /> SAMPLE <br /> MEASUREMENT / <br /> ;':~;..PERMIT~. ~~... <br />, <br />.. .. ~ :: .. <br />r ~' ~ .. <br /> <br />: <br />~ ~~. <br /> <br />.~: <br /> . <br />: <br />.REOUIREMENi:. ~.. : . ~ . . <br /> SAMPLE D L i <br /> MEASUREMENT ~ V _ <br />--. <br /> .: ~~ .PERMIT ~: ... ~ . <br />~ ~ : / . <br /> REQUIREMENT ~ ~ ~% ,~ <br />.' ~ ~ ~~~ <br /> ~ <br /> SAMPLE <br />E <br />ENT <br />r <br />1 V <br />' <br /> MEASUR <br />M <br /> ~:~::::~:PERMIT":.` . ..: :. .. :.. ~ <br />; .~~ .: <br /> <br />;REQUIREMENT: <br />.'..: ::...., :. ... <br />...~.~ .~.:..: <br /> SAMPLE /' <br /> MEASUREMENT ~ / <br /> <br />::::"::~PERMIT'~. ~:~: <br /> <br />:. <br />~~~~~ <br />:.:.. <br />,.. ;. <br />.. <br /> :REQUIREMENT. ~ <br /> SAMPLE <br /> MEASUREMENT <br /> aERMIr .: <br /> ~~REQUIREMENT <br />~ : <br />~ <br />NAME/TITLE PRINCIPAL EXECVTiVE OFFICER ttnnTu rr prn.l)° <br />'.In.l Wndmimrnl and rll.nncn..nl.+rn <br />I <br />TELEPHONE <br />DATE <br /> prtP.nd nMa mr dlncnon or ruprnlrlon In raa°N.me .uM1 . gnrm dalpird <br /> m.ourt lbl qutllnedwronna prgrdT plM1w.M eolua lbe ln!°rm.lbn <br />Saed°n mE lnqul <br />of N. <br />rronw <br />mluiNN <br />nmr+Ao mpn <br />e lM a <br />lem ~/ ~ <br />/ / ~ ~ % ~ <br />~-~L-~ -~~ <br />' <br />I' <br />~ <br />' <br />~ q <br />p <br />. <br />p <br />g <br />p <br />, . <br />~-• ~ ~: <br />" <br />/ <br />TS <br />. <br />' <br />~1- <br />IM1• "JS~;.; . nr lM1~prvmdlraa1y mpe1Nn1n1e rw Plnednp lM1e lnromunm.lbe lnrornrnon f_ <br />_:y <br />~.~' i~~~ (1~ j <br />O.-.. ~'.+ .r'(:d'IP TAi 'ia~~..~r ~~ <br />_ - - <br />` ~ wbmluN b.l°IM1e EnI°f mr tm.kdp.M bellrL lr°e, wavntr, and mmplrlr. <br />Lm...n Runnrrt.rt ppmnom pmmm~ mr.°emlum <br />r.~mmrmaln+ <br />{IONATURE OF -IIINCI-Al E%ECUTIVE <br />TyPED OR PRINTED , <br />E <br />Iw1WInLiM ponlGllllr°fnw.M lmprlanmenl lnr L~q.lnr rlolnn°m OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION or A.nr r1UL~ I Ions rNI/I/IOCI Ni ~rnrnm~nra n~r~l <br />. r- <br />;. .: I . <br />EPA Form 3320.1 (Rev'3/99) Previb8s editions'rliay"6e used ~~ ~ ~~ ~ This is a 4-part form. vnGE ,oF <br />