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PERMITTEE NAME/AODRESSpnei~~r F.rWryNw/lollnon(/Otairwu) <br />NAME <br />ADDRESS _.. _. .. .,. .._. .. <br />• nJX 1'•13'J <br />~bJr. CL Ei <br />FACILITY ;, I V !'.• h U !: Z +": G v l: it 1 }. ?1 l h t <br />LO~~ ~bLISAlii CG r, <br />NATIONAL f OILUTANT OISCHAAOE EiIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D RI <br />PERMIT NUMBER asc{+AROE NuMeEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />t - P~l `h i i <br />-- <br />NOTE: R~~d IrnttvcNoru b~toro'complotinp thle+ }wm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FAEOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ Y i "1 ' <br /> REQUIREMENT <br />,. <br /> SAMPLE <br />' MEASUREMENT ` <br /> <br /> PERMIT <br /> REQUIREMENT <br />~ <br />~ <br />r ~ r ~ i~ ~-'; i i. <br /> <br />_ SAMPLE <br />. <br /> MEASUREMENT <br />. PERMIT <br />REQUIREMENT - ~ ~ ~ :: ~ r ~ ~ A C Y / - . .... <br /> <br /> SAMPLE , <br /> MEASUREMENT <br />~; <br /> PERMIT ~ •J ~. - ~ ` .: i- 7 L L ; _ `.•. / <br /> REQUIREMENT <br />J I <br />~/ ti <br /> SAMPLE <br />! <br /> MEASUREMENT <br /> PERMIT ~ .. ., <br />_ r i... '. <br />i_ , <br />I <br /> REQUIREMENT <br /> _ :i <br />• SAMPLE I <br /> <br />~- MEASUREMENT <br />'J _ PERMIT _ . ~ " .. ' i i i i, ~ 'i h . <br />_, u :. ,_ J ~„ y REQUIREMENTC i Y <br />_ <br />it ., , { SAMPLE - <br /> MEASUREMENT <br /> <br /> PERMIT ~: " _ ,. .: .. -=r<.L'c ~I~~t~i <br /> REQUIREMENT - <br /> . <br />K <br />NAMElT1TLE PRINCIPAL EXECUTNE OFFlCER .nd ." .Il <br />nmtnu .rrt <br />"!""] " `r p!""] ° I.w In"'"h documtnl TELEPHONE DATE <br /> prep.red under m] dlrert{on a nrper.iyon In .ccord^me wlin . t]sltm dd~ntd <br /> <br />- ro aare thN go.Mfled personnel proprrl] plner .nd er done IM tnformallon <br />loemllled. e..le on m. Ingwr] of lne person or persals wn° n,.n.it the . <br />rum <br /> ] <br />. <br />or Ihofe ptn°rn dlrttll] rrrporNbM for (.Ihert n~ lne Inform.llon, Iht Informsllon <br />- <br /> wAmllled kr, l0 the bct of T] knowkd(t !nd belief, Irve, Krvnlr. •nd cempkll. <br />I •m ^w.re lhll Inrn .re sl~nmunl pen^trllr rnr anminln= r.He Inrormsllon. '-- <br />6IONATURE OF -RINCIPAL EXECUTIVE <br />' <br />TYPED OR PRINTED Inrludlnt iAe pnnfEnn. or nnr erd Imp"sonmenl rnr Mnnwln~ .lnleuom OFFICER OR AUTHORI2E0 AGENT CODE NUMEfER YEAR MO DAY <br />COMMENTS AND EXrl~rr~+l Ivn yr nn r •IV~n 1lvna 1/T~nrmc• M •lr~cnm~nu noisy <br />_- r , <br />EPA Form 3320-1 (Rev. 3+99) Previous editions may be used Th1S is 8 d-p8rt fOTitt- PAGE OF <br />