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I'ERMITTEE NAME/ADDRESS pwdrJti.rWryNw/Loe.rrar f/OrQltrwrr) NATION AI POLLUTANT OISCNAAOE ELIMINATION SYSTEM //NPDESI <br />NAME DISCHARGE MONITORING REPORT IDMRI <br />ADDRESS r <br />.. 1 .~ ~ , t .~ . . i . _. ., r ,. : t et _. <br />• 1;(iX 14,iU PERMIT NUMBER ascl+AnoENUMeEn <br />A D ~ C`- ~ MONITORING PERIOD <br />FACILITY y I Dr. h r~ R T h F ~ C <; T it :1 i YEAR MO DAY YEAR MO DAY <br />IOCAT1pN ~. n L I :i r1 D $ LL FROM ~ TO <br />- . xt t v r r n .. •. r ~~. <br />Form Aoprovea <br />OMB No 2046-0004 <br />F - FI dA:. M E:.-A <br />rCil+:1 ~ IG CCiCF.i1GC .~1Vf:t <br />NOTE: R~~d Imtrvctiorta b~fwa crtrr,nl~tina thl• loan. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO- FREOUENCV SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX 't'N~Y~s TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> - <br /> REQUIREMENT ~' '; <br />7 ' ' ~ ~ c r.:: t~ ~ 1 . L <br /> <br />• ~ ~~ SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />~ ~ <br />' ` <br /> REQUIREMENT r ~ <br />_ <br />r SAMPLE <br />' <br /> MEASUREMENT <br />_ <br />} PERMIT , , ,,; <br />~• • r ~ 1' i <br />:~ t. ,. / <br />r t ~ <br /> REQUIREMENT ' ,r hl ~ <br /> SAMPLE <br />t ' <br /> MEASUREMENT <br />I... <br /> <br />- - PERMIT „ r r. r _ <br />~ :- `~ (. <br />', ~ ` / <br /> REQUIREMENT . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br />... • Y <br />: c : G ~. • <br />: h <br />.~ .~ r <br /> REQUIREMENT <br /> a} i <br /> <br />~ SAMPLE <br />( <br /> MEASUREMENT <br />_ PERMIT <br />REQUIREMENT N l'1 ~.: .: z. F c.. , ': <br /> <br />' ~ .: ~ ; <br />~ <br />' <br /> :. ~ r <br />:1 <br /> SAMPLE - <br /> MEASUREMENT <br /> <br /> PERMIT r •_: ;•. - - _ .... - I <br />' <br /> gEQUiREMENT - <br /> j <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER t re tY"r ° ' p`"' V o Lw Iha lAN docV IIKN ud dl ttllKhrnrnh weR <br />prep.ree order mr elrectlon or supmttron In Kcord.nn with .them detr(ned <br />TELEPHONE <br />DATE <br /> to rmure tn.l qu.nned prrsonnel progeny (.Ilrer end e..lu.te the InrorrMtlon <br /> wbmltted. 6~ed on mr Irpulrr o! t)re pereon or pereoru who rrnn.(e the srttrm, ' <br /> <br />' or Ihott pcrwro dl recur resportdbk for (.IhMrr( the Inforwrstton, the Inforrrullon <br /> <br />- wbmitted It, to the bnt of mr Lnowted(e erd beeef, true, Kilrnle. ^nd compkle. <br />I .m ew•R Iha IheR eR tl(NndM pendnd C r tubmltdn( r.lte lnrorm.flon. <br />EIONATVRE OF -RINCIPAI EXECUTIVE -" <br />TYPED ~ PRMITED tnclydln( the podbinlr or nne end Imprltonmenl rot -rrowln( .id.tlo,rr, OFFICER OR AIITHORIZEO AGENT CODE NUMEiER YEAR MO OAY <br />a.vmmct~ t~ nnv cnr ~.........,.. _. ..... ..__...._..,, r..~,w....,,w w.. ~..~.......~.......w..r <br />~ ,~ r <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. is is a ~l-part Corm. <br />