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PEpMRTEE NAME/ADDRESS(!wd/r FsWryNr'Lr•rra./old r•tl NAilO11K POLIIrfANT gSCXMOE fLIMINATON ST4fEM NPDESI <br />NAME .. DISCHARGE MONITORING REPORT (D Rl <br />ADDRESS _ ~ r ~, -., ~ . <br />J PERMIT NUMBER ascgPADL NUMerA <br />FAaLrrr MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> <br />NOTE: Rrr~d MNtrucOorr b~lai~complNlnp rhb ram. <br /> <br />PARAMETER QUANTITY OR LOADING <br />Quality Or Concentration <br />NO. rgrOUENCr <br />SAMPLE <br /> EX DF <br /> µKY4s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />.. .. SAMPLE •~ ~~ I _ <br />, MEASUREMENT <br />I .: .PERMIT..::::: ...,. .. ',. ~ :, y•r.~;`i ~'; :~.~: _ ' <br /> ~RE~UIREMENT~ ~ ~ ~'' <br />- , . ~ SAMPLE - .. <br /> MEASUREMENT <br />t .' -PERMIT' .. ~ ... .Y r •<r<~ .. n ra . _ _ r <br />- 1 ,- /, ~, , :REQUIREMENT. ~ - i <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> " <br />' <br />~'.:. " <br /> <br />...: <br /> REaUIRE <br />MENT ::. <br />. <br />. . . ~.. ,:•r; <br />, <br /> . , <br /> SAMPLE <br />EASUREMENT ~ ~ <br />~ A <br />f ~ _ <br /> M ~ r~ <br /> ~ <br />~ <br />~ ~~ <br /> REQUIREMENT ~ ~ V ~ <br />~ ' ~ <br />~ <br />' ~~ ~ <br />~ <br /> SAMPLE I <br /> MEASUREMENT <br /> <br /> :qE.OUIREMENT•. <br />.::....:... <br />:':::..::'..::::.' ........ <br />, .....•. <br /> <br />~: . ,',.... ;.:. <br /> <br /> <br />,.:. <br /> <br /> <br /> <br />...... <br /> SAMPLE <br /> MEASVREMENT <br /> :::::;.'~PERMIT'~..~~:":;. ~.. :'.: ~ . ...:. ~ :.. ~ ~ . ...:... .... .. <br /> AEgUIgEMENT: .:.. <br /> SAMPLE <br /> MEASUREMENT <br /> .::.:.:.PERMIT '.: .. .. <br />~: ~ <br /> .REQUIREMENT' ~.~..; ':' <br />:.. :.. .. <br />.. . <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER ' °""r ° "P'"•'r ° •` N•I N <br />prtvrte•nerr mr elrtcn°nxxP• b envlmnl •ne •N •II•chmrnu Overt <br />^bl.n In •rmre.nn wuh. q,l•m eeln.a <br />TELEPHONE <br />DATE <br /> <br />. 1• •vurt Ih•I qu•Mn,d prrunn°I PmPrtil i•Iher •b e.•h•In Ihr Inf°rm•Ilon <br />rhhMlletl <br />n.wa on m <br />lr <br />l <br />of Ne <br />non <br />h <br />ll <br />~ <br />' <br />~' <br />~ <br />~ <br />'~ <br />;. <br />~ <br />i:J f (I U' l EE ~ B' S <br />Y . <br />r <br />qu <br />q <br />A <br />or p<mm w <br />nmugn <br />w,plem. <br />h ' <br />_ <br />~ <br />~~ <br />~ ~ - <br />'~` / <br />~~ <br />" <br />' ~ ~ , . <br />1. %1- j~' i ~iL v ~ <br />. <br />' nr I <br />ov pmm elrMl/ repMhY for plherlni Ne Inf°ml•Ilm, the Infnmutl°n ) + <br />. <br />~ <br />.H i.1L'q:: <br />,2'.eLa! ' <br />PCeJi.Ict:C whMU.eb, mmnhnlnrmrhn.aeeir•nen•n•r.w•.•m.rtla.nanmvbp. <br />, 1•m•wmN•I lhm mYiNllum PemlOe forehMlery hl~lnfonn•Ibn, fIONA7UgE OF /RINCPAL EXECUTIVE <br />TypEp OR PRINTED 1"rlnalni m. ~nhnlry°rn,..na lmpr+snl.wm rn..n".Ini .!a.uwn OFFICEq Oq AUrHOp11ED AOENi C <br />E NUMBER YEAR <br /> OD MO DAY <br />COMMENTS AND CAr~wnn I Wn yr n... .,vin uvna Irtnt/rmct/ ur r,rrr.cnmmn nnP/ <br />EPA Form 3320-1 (Rev 3/99) Previous editions Ri3y~be used. ~ ~ ~ ~ ~' ~ ~ ~ ~ TINS IS 3 4-pert LOfm. PAGE , OF <br />