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PERMITTEE NAME/ADDRESS pwei.iF~eMIryN~./Lecr(ew(/D~...rii NATIOwAL POLLUTANT aSCHMQE EiIMINATION Sy9TEM NPOfS1 Ferm Appro:ed <br />NAME DISCHARGE MONITORING REPORT /O R1 <br />OMB No 2040-0004 <br />i <br />ADDRESS ,,.1 i ,_ I'dU. c P>III'.1- <br />..II? ~ r- <br />~J BLIX 483 PERMIT NUMBER ascHArtQEwUMeEn _ <br /> <br />JN j A MONITORING PERIOD <br />FACILITY ~ 1 ~ NL`l. ~ M I h'!.- YEAR MO DAY YEAR MO DAY <br />LOCATION. IN 7 A FROM TO <br />~- Ll_ I AM A I3 FAA"t~ , ; F~ ~i ; is r. I.~ NOTE: Read k»trvctlorn b~fw~ compl~tlny thl~ tam. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. fREOUENCY SAMPLE <br /> of <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAIr~s TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT • , <br />~~ <br />~ <br />REQUIREMENT <br />t} <br />Dr`;, SAMPLE <br />,1-1 i~, , MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />~; <br /> SAMPLE - - <br /> MEASUREMENT <br /> <br /> PERMIT ~. ~rx i'r~•et ~ - ~ It#~s ~'='1 _ "F~ r'r$ <br />' ~ i_UL(J' •:,R(:'= REQUIREMENT ~ r,, .,, <br />t.. <br />.i -. , {^f <br />~.~, ~ ilj~~.i. SAMPLE <br />. =; ti <br />MEASUREMENT <br /> PERMIT ~##~r - ;•+py =, ..,~:.;. <br /> REQUIREMENT <br />• ~' ~: ~.. SAMPLE ~ - <br /> MEASUREMENT <br /> <br /> PERMIT ;; ~~ ;• ~-~ I ;~ _ _ I ! .) <br />- <br />'~ ~ <br />Y REQUIREMENT <br />X NST h^ ~: <br />r: ~ ~ <br />i SAMPLE _.. <br />i I RFA i I"ira~i i P~. MEASUREMENT <br />- ~,~ i r, ~ PERMIT r -~~: .- :L F'` .?.~ i-. <br />. REQUIREMENT - - ., ~ TI '~ <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT _ ,. - ~ ~ ~ :x•.;..: ~ 5 <br />REOUIREMENT <br />NAMERiTLE PRINCIPAL EXECUTIVE OFFICER ' "^"r " e' a"''r ° " Ihst Ihh davme"t .nd Jl .Itsrhmenls .en <br />TELEPHONE <br />DATE <br />prepared under n,r dlrsrtlon or super+hlon In serordsrter »IIh . system desl[ned <br />to Haute Ih sl dushlled personnel Pr~~r [slher and e~sluNt IAe Inrermtlbn <br />subrrrtted. Bred on mr Inquiry o! the person or prnoeu .he rrons[e the tystrrn• <br />or Ihoet person dlrectlJ repotnd bk f« [tlherlrt[ the Informstlen• the Infoemstbn ~ <br />submitted k, b the bet or m~ Lrto.kd[e srtd beNef, Irvr, smrntt, trtd rempkte. <br />1 srn ^wsre Ust there ors sl[Mflnnt pendtle roe submltdn[ false Infornrtlon <br />iIONATURE Of -RINCI-AL EXECUTIVE <br />TYPED OR PRINTED , <br />trKl,.dltK the poalblury or flrtr the lmprtsonment roe ~no.ln[ rlelsUorti OFF{CE11 011 AUTHORIZED AGENT CODE NUMBER YEAH MO DAY <br />. _ Il`t'T ~-HF? t~f~r-.•~~n, r.~rc-~l-r T•, ~•t ~-xc.rFT• ~r' f'! A t1PF'R(1'1Fi.! F:'• o?^!= <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions maybe used ~ ThIS IS 8 4-p8rt COfiTt <br />