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NERMITTEE NAME/ADDRESS (!wrliv FeeYfryN~r/Lsrr/an (/DlQirwq <br />O <br />NAME <br />ADDRESS _- ~`J <br />V <br />GG~j <br />~ <br />1 7 4 w ``d~ <br /> ~~ <br />rr-; ago <br />\ <br />FACarTY r ~' d~\ <br />e <br />~ <br />~: _. ` `E~ Kati <br />f•1 I F.: ~ <br /> <br />NATIONAL pOILUTANT DISCNMOE ELIMINATION SV4TEM //NPDES/ <br />DISCHARGE MONITORINQ REPORT /DMR/ <br />PERMIT NUMBER dSCNMOE NUMEEA <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br />pproved <br />RECEI o 240-0004 <br />Fv-/FIt- N~V ? 8 2~~~ <br />RUi+t7FF <br />pivision of h~c.:::~ ~=.on, <br />~~~g and 5PI WY <br />NOTE: R~~d k»trvcdorr b~fw~ cofripl~tinp thh form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREO <br />V~NCY SAMPLE <br /> O <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAtrss TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ::.-#~ ~ •_ ~ z <br /> REQUIREMENT <br />;f=,X i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :. a- r <br /> REQUIREMENT <br />i~ ~ i L I` i`T , _ <br /> , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. -~_.£..:: ##i!•##•i•` ii## ~: :~ -k••~r# ~ ; •,i .•. f~,; <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r, ~, I~ a .:-,, , .. f- ## _- _ , . <br /> REQUIREMENT ;3UDii ;` I`1 ii <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ?-~ i ~ ;. <br /> REQUIREMENT :i}~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENTC <br /> SAMPLE -- <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME/T7TLE PRINCIPAL EXECUTNE OFFICER ' rrA"f ° r` pr""' ^ ~•" Ina Uti d«v mrm .ne .n .~,Kn,„r"t, .ere <br />r <br />d une <br />dl <br />TELEPHONE <br />l <br />H <br />l <br />DATE <br />p <br />epsrt <br />recl <br />rr m~ <br />on or ruper <br />S <br />on In srrnrdsnR ritn . f.Aem adinre <br /> to care IhN qusllfled prnonnel propeA~ Esther snd r~sWsle the Informslbn <br /> ssAmllled. 6seed on m~ Inquiry of Ote person a persoeu rho m.nKr lM r]rlem, <br />th <br /> or <br />ose persolw dlrerll~ respetMltk for plheA~ Ue Infornullen• the Informsibn - <br /> suArnllltd h, to the Aesi of me tnowkd~e snd beMef, Iroe, orrvnte. snd rompkte. <br />r I .m .r.re u.I them .re fl~nlncim penatla for ahmlmn~ rslse lnrormstlen• f10NATVRE OF -RINCIIAI EJ(ECUTIVE <br />TYPED OR PRMITED Inrn,alnethrp~fenlgofnnr.nalmpA,onmr,~t for r<~w.tn~,ld.uot~ OFFICER OR AUTHORIZED AGENT CODE NUME{ER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rtrl~i~nc~ ~N •K~chm~nfs h~rrr/ <br /> <br /> <br />EPA Form 3320-t (Rcv 3 99i Prev,ous editions maybe used Thls is a 3-part form. PAGE OF <br />