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PERMITTEE NAME/ADDRESS (Include Fanfiry NamaJLocarian if Different) <br />NAME L'. '~ ),1 } ^ .: ;~ ... ~'t ; Y , ['... . <br />ADDRESS: ~ ;, _ ;~ y J,.i , r y.; <br />~Jf _}~~~. .t ham.! "'J <br />FACILITY <br />LOCATION <br />,~:v ';, <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NRDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />^il lir.1 ~' ~ r' <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ ' TO ~' ! % ~ S i <br />Form Approved. <br />OM8 No. 26400004 <br />~I)K <br />r°it ~: w) <br />`J 4 T <br />NOTE: Read~lnstrudions before omplefing this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br /> EX OF TYPE <br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS avaLrsls <br />' '' SAMPLE ~ ~ ~ ~ ~ ~ ~ ~ " <br />( 11) <br /> MEASUREMENT <br />J 1 - l PERMIT` #•,rAtRc'2# Ot34X<Tk0 t:''""~ 6•$'' 33#### 9.0 L"'~K~~Y "'8~1' <br />r.r" :. 1 '•I' `: ~ 1-_, ViLu. REQUIREMENT "!!I(gj~yjJ'! !1A UM SJ <br />-~-'-/~`r .•~~ 4L SAMPLE "f .=d t- .,-. ( 1~;? <br />... :. `+ i'.: MEASUREMENT <br />J~ , iJ i ,/ PERMIT 9#4rA~4'S t ~bt#44 t~f d444 ~ej 70 - °" ~~' 'jL~,:~'- <br />;r; ,.'J^ .~ ILC, REQUIREMENT •~ ~ 3UDA AV^ OA LY ~'i °'" ~~ 11D N <br />.i I L ~ , N .: F.. a SAMPLE r: a": ;: ....:. :k ^ :;: r::: r ( 1 ' ) <br /> MEASUREMENT <br />;: :7'~7:• 1 U PERMIr u91#4x# 3a6+6L4#4 e: c:: 443R3Tk eX44tr#0 IO OMT3~~ <br />~. i'r'L~J ~:"` •.73.i V1L'u, REQUIREMENT ~ ~ INS'I id AY `/L <br />1nJ ., CUf:L SAMPLE ... ... . .:rare r, ;:;:#;: -::~: ( I~l) <br />(A ,; ~ ';) MEASUREMENT <br />J1~:J 1 .1 U 'PERMIT #LT#qk~## ##4R4A1 <br />~ +z~'t R4R#tl101 3.5 .. 7•'~ t9L*$/ .~ s ;. <br />h. h'r ;.a..a f :, ~J:;? VgLU~ REQUIREMENT ~~ • : ~ 39UA AV's UaI LY PIY P ,/L HOfl'f - . <br />'I.J ~, f.: ~'t~D`.i :''. 'f SAMPLE ('i"j) .{: {::. .. <br />.I .. `..L' i:+ f L;. ~.^ MEASUREMENT <br />,'f'J~) 1 - U PERMIT •HL+P`3RT ' AP.POftfi aq!4ilt#4e 3b4q## ~: 3#4+pr## " ': `.r i. EEF.LY -. <br />L) 't . 1' :; ~ J , ~ V 1 (.'l a REQUIREMENT 30 D A ;r V,: !lb I LY h Y :k F„!.r <br />: ..._i, Jf'. .. SAMPLE ., ~ .._. .... ., •; t:-.: ( 14~ <br />l ~ r •: ~ ~ <br />~ MEASUREMENT <br />/ "~ ", <br />~ •- 'J PERMIT" ". ' ###4#C'~ :`;'±614#40i ~.~<,~ :.ye yi# ~" P43Ttt r€ fl~'"~~~~. Ti~L3' `itA'8' <br />rc L;~~. <br />gq~:_ REQUIREMENT - ;!('1"~ dVt"a .. ~ ,A' '^'/L I <br />_ <br />i ~ ~ ~ . ~ 1_ SAMPLE = Ir ( ..I) .. <br />... <br />:. :. .. -.. , <br />... <br />~.~; t MEASUREMENT <br />.". .1 ...~ _ '• PERMIT. ..3 bgt3Sfi. D "-._ '. ",=1 013#### _ ##3>fs## _- _ .#IC 4i}0:?4 :r~~: .. ~ Ia!lA <br />i. ''~ t:: `. 'J ?.~Jh REQUIREMENT I615T MA$ ".1J=~~ ".'".'~~" <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I CerLly under penalty of law Thal This document antl all attachmanLS were <br />tli <br />i <br />i <br />i <br />rn <br />t <br />d <br />i <br />d <br />d <br />i <br />tl <br />tl TELEPHONE DATE <br />/ <br />~ / L ~ n•1 ~ <br />/ P <br />(./I- <br />S prepare <br />reg <br />on or superv <br />s <br />n accor <br />ance co <br />a sys <br />em <br />es <br />gne <br />un <br />er my <br />on <br />to assure that qualified personnel properly gather and evaluate me mlormatlon <br />_ <br />, <br />c L ~ <br /> subminad. Basetl on my inquiry of the person or parsons who manage Ne system, <br />~ <br /> the inbrmabon <br />or Ihose parsons tliretgy responsible br gathering the Irtlonnalion <br />`_ <br />~ <br />I ~~~ ~ , <br />knowled <br />aaurate <br />and com <br />sub <br />th <br />best of rt <br />ntl ballet <br />we <br />lete <br />in <br />d i <br />t q <br />~/ <br />t - <br />f <br />L ,) ,~ . ry <br />ge a <br />, <br />. <br />, <br />p <br />. <br />m <br />e <br />s, <br />o <br />e SIGNATURE OF PRINCIPAL EXECUTIVE / <br />~ ~ <br />~ .( O ~_ <br /> <br />TYPED OR PRINTED I am aware that there are algnisram penalties for submming lalsa information, <br />inclutlin the ssibili of she and im risonment for knowin violations. OFFICER OR AUTHORIZED AGENT AR <br />E <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />, <br />EPA Form 3320-1 (REV 3/99) Previous editions may be used. r J ~ 2 y / ~ J 1J ,) iT~IS19 y 4"PART FORM PAGE I OF <br />