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PERMITTEE NAME/ADDRESS Nnc41dr Fxidry.Wunr/Laavritln iJ(hfJrrru) <br />NAME -. „rf1, L_LG <br />ADDRESS - ~ ' ~' <br />f.- -_ -= <br />•~; ~~ 81.424 <br />FACILITY ;-;fit j ZC1T•~ i~: ; ! •: __ <br />LOCATION -_A C ~ t~ '~ c~~ <br />I...AititCF L:~;DE. r+IPd~ t~I~1A{~Eft <br />.~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No- 2040-0004 <br />~ U3Z1Vv 1 r(Y ~', <br />_ ?'---- <br />NOTE: Read Instructions t>'efore completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ z~~ .: ,. - _ ..- _ .._ ._ <br /> REQUIREMENT `-'I.•!: t il~i" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. ~:. : 1- .; • , . . <br /> REQUIREMENT ~ , - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r. ~ r. .. L;: • r ..:., - <br /> REQUIREMENT -':",j,}f:, ,' - 1::.:. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ r - . _ ~ _ - - , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ,: - . .- .. r _ .. ~ _ <br /> REQUIREMENT - '-~ • ~' ~ `- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT .. _ .. <br />:f i- -!:~ i; <br />`-i•: T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,._ 't:~; i r!:..; ~.•, ,. - - - - - - - . -.-. .~ .. <br /> REQUIREMENT = 1: ~"- _` .'•;_. ~i~ ~ t-. r' '•L% . <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I rerun ender prnaur onow Ihal thi. docnmrnt and an a11]Chmene+ weer <br />dinriinn or w <br />rr <br />an~d under n <br />cn Li.rn fn an.rrdann• whh a b <br />slrm desi <br />ned ~ .~ <br />/ r TELEPHONE DATE <br /> p <br />p <br />q <br />p <br />y <br />g '"' <br />~ <br /> In auure thnl qualified pervonncl properly gather alld evaluate the informatfoo ~ <br />" ~ <br />i <br />-'"" `-~.- .ubmltlld. fiaxd on my inyuirv of the prrvrn or pelwrta who mamKr the gHrnl. ~ ~_ <br />~. - <br />_ or throe prnun+dira~a-lly rrcgmsihlr rr,r grthr ring Mr inrornwlion. the inG/rmuliun _ <br />-' ~ ~. <br /> <br />~~-.-1 - ;~ <br />- <br />whmBted h, la the hest of my knoatedge and lerliel. Irue. accurate. and completes <br />I ~m aware that Ihrrc arc ~i <br />nifiavm <br />rnalliir l..r .ubmiuin <br />(aloe Inrormation <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />~ ~ /(1 _ <br />~, ' ~ <br />~ '' <br /> <br />TYPED OR PRIP-'fED g <br />p <br />. <br />g <br />locluding Ihr lxresibilitc rd fine end impriwarnom Ln Lnowing IioluWmti <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />VVMIrIGi\IJ NI\U GAPLMI\MIIVI\ Vr HI\1 YIVLNIIVI\J (/\C/C/CIII.C tll/ tllltll:ll/lICIII, I/CI C( 1~~1 <br />.1~ <br />EPA Form 3320-t (Rev. 3159) Previous editions may be used. <br />Thls 1S 3 -~-~1;1T[ t(>fm. PAGE OF <br />