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F'ERMITrEE NAME/AODRESS (IneVir F~rWryN../Leer,aw t/OtQi.wu) NATIONAL POLLUTANT OISCHMOE ELIMINATION SYSTE/N /rNPDESI <br />NAME DISCHARGE MONITORINQ REPORT /OMR/ <br />A~ORESS <br />~.: U ~ Z 7 ~ - PERMIT NUMBER ascHAAOE NUMeEn <br />MONITORING PERIOD <br />FACIlt7Y fy(~, ~ f"(j ;•.I YEAR MO DAY YEAR MO DAY <br />LfkAT1oN RwET Cpl E M. FROM TO <br />~IE! E. f3!~AR, PRESIdEIVT <br />Form Approved. <br />C~AAB No. 2040-0004 <br />F - EINAt_ G <br />f'I I NE dRA I P.iAGE TO N FK GUNN I S©N <br />NOTE: Raad Irntlvctlor» b~fora compl~tln9 this form. <br />PARAMETER QUANTITY OR LOADING pUALITY OR CONCENTRATION NO. FREO <br />U <br />ENCY SAMPLE <br /> O <br />f <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .:r#=: _. G ~ c <br /> REQUIREMENT f ~ I N I f-:. i'iF^ ;~ 1 hl'•.; i•' <br /> SAMPLE <br /> MEASUREMENT <br />~, <br /> PERMIT :, -t F'r-~ -: (~ <br /> REQUIREMENT - <br /> SAMPLE <br />- ~ MEASUREMENT ~ <br /> ~ <br /> PERMIT -Y -: zv ##~~~•## - t ., '.; _, iJv ra~. .l ii .., <br /> REQUIREMENT ~, , vF;IL.Y i'9iC ""~ ~"~fTi <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT '~- ~>-~•~ ~it~•~~F~t# ~#~•#-~ ~ sF# st# 1 •. .r=:: <br /> REQUIREMENT ~ - <br /> SAMPLE <br /> <br /> MEASUREMENT ~ ,~_ <br /> <br /> PERMIT .l t_: ~ ~ ~ ~ ;f ,r ?,f.7.zw ? <br /> REQUIREMENT 'c)i , ~, ~. ~ L •., <br /> <br /> SAMPLE ' <br />,:~~._ MEASUREMENT ~. <br /> <br />Y ' ` PERMIT • <br />=:;,! i REQUIREMENT ~`3T MP. <br /> SAMPLE - <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME./TiTLE PRINCIPAL EXECUTNE OFFICER t cendr . er pen. ty o Lw thet Ihb document end NI etlechmenb were TELEPHONE <br />d <br />l OATS <br />prepare <br />Ynder mr d <br />rectbn or wpenNow In .ccord.nce wllh . ly+tem det[ned <br /> to care thM yoenned pereonnN P~PeM nth.r .rd eselu.te tM Inrormellon <br /> wrbmltted. O.eed nn my Inquiry of the prnon or persoru who rn.na~e the system, <br />i <br />~ <br /> or !hose parlors d <br />rectly repoMbk for [.theAn~ the Inforrrutlon, Ilse Informetbn i <br />` <br />~ <br /> abmltted LL. W the bet or my ktsew4d[e end bailer, trw, etcu nte..nd tompkle. ~ <br /> <br />I •m sore lhel !here er: d[rslflnnt pendtle for eubmllNn[ bNt InfermetSon, <br />{tONATVRE OF -RtNCt-AL EXECUTIVE ' <br />- ". <br />TYPED OR PRINTED I^~~in[tAepo~lbltltyorflne.wdlmyrlsonmentfor-nowln[.Id.Uotu OFFICER OR AUTHORIZED AGENT COOE NV~R YEAR MO DAY <br />a.vmm~r. ... ..•... ~... ~..-...-_._ _- --.~- ~-__-.-. _.-_ .~. ~.-..-~ ~..-..-_.....-..._.. ~. ~. <br />~ i.. 'LI <br />EPQEtTEI <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used - `4 ~ This is a 4-pan <br />