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PERMITTEE NAME/ADDRESSpnaVilFailtryN~w/ler~lren(/n(Qir..nq NATIONAL POILtJT/WT DISCHARGE ELIMINATION SYQTEM NPDESJ <br />NAME DISCHARGE MONITORING REPORT ID RI <br />ADDRESS ~._. c ~~ <br />IiQX ~~.~ PERMIT NUMBER ascNAROE NuMeEn <br />I ~' ~' MONITORING PERIOD <br />FACILITY ~ NQ. ~ M i, rite YEAR MO DAY YEAR MO DAY <br />LOCATION , ' i /~ [ (] $ 1 .~; FROM TO <br />T Ah1 A T; FAR .1F? M T IVE P'If'' <br />Form Approved. <br />OME3 No zoao-ooo~s <br />(~VI~1~ I•Iti! <br />F - F ~ ivAL <br />SR; DFFFt -i RL CtTC OFD UNhiC TI <br />NOTE: R~~d If>•trvctlor» b~1w~ eompbtlnp thb form. <br />PARAMETER QUANTITY OR LOADING pUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCV <br />OF SAMPLE <br /> ANarsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. ~ ,:. , <br /> REQUIREMENT ~ <br />MiJr <br /> , ~ <br />1 <br />~ <br />- SAMPLE <br /> MEASUREMENT <br /> PERMIT - . . <br />,- REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />:~ PERMIT x ~!-~-4t~•~ ;- y r• - ~ : ~ - ~, <br />~~~ REQUIREMENT '~ •i .n i•iUN ~ N <br /> SAMPLE <br />- MEASUREMENT <br /> PERMIT # d.# - ~~ <=-.- ~_ i ,,~` ~'., E _. <br />.. REQUIREMENT ; ~ :~;,-.r. <br /> SAMPLE <br /> MEASUREti~ENT <br /> PERMIT s: # 2 .~ ~. r ~ # :. s'. n~ f ,, n ~~ <br />-~ ` , REQUIREMENT <br />I•if5 ~' <br />- ~ , SAMPLE <br />pl MEASUREMENT <br /> PERMIT ;"'EPL7R ~ 'rpOR i ~.:~ sr~-~ ,. , - ... _ ~-, ;~~. -. <br />- v,~, REQUIREMENT ;_;r'iDA f-+ • I LY I•. ~ <br />~, SAMPLE ,::< ~ <br />IL MEASUREMENT <br /> PERMIT ~~.~ .,, cr'1F k-tE•~•tF~i# .;-ws: ; '.~•#~; .. _ .- .N~ <br /> REQUIREMENT - <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER ' """r " ' p•"•'r 1.- iha ~ ti documrnl .nd .n.n.ch1n enb ..,< <br />TELEPHONE <br />DATE <br /> prep"red "rider m, elrertbn o< eupe nlflon In .aord.nce .Itn .:~etem dd~nea <br /> to ..."nr th.l ~""nned personnel properly t.lh.r .rid e.w.tr the Inrenrutlon <br /> selfmltted. e«d en Inr Ingolrr of the person er pennm whe m.n.~e the lyeum. <br /> or those persern dlretll~ rdpotllf,k for ~sthrrlnt the Infonnsllow, the Inform.llon <br /> whmltted h. to the -ett of rnr tnesr{M~r ^nd fxKe(, Iroe, K/vn1e. snd tompkle. <br /> I .n, s.sre that !here .n .I{nlnc.wl penslnes !or ruhmlltln <br />fralw Infe <br />tlo {IONA TITRE Of -AINCIPAL EXECIJTINE ` <br />TYPED OR pR~~p E <br />rme <br />n, <br />Inrhrdint tM posdbl9lr e<nne snd Imprtsonmrnt for Lno.ln~ rld.tlotea OfF{t;ER Oq AUTHORIZED AGENT A A <br />COt)E NVMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRS/~r~nc~ Nl' •Krrchm~nta h~r~l <br />~- :~'i_ ~c~r..rs7 r-.. r, •.rM7=' - ('~ r"~r;rl ~~~~r_t~~~lr_r~ Pv It1.-~~_~', <br />. ~ l . _- ~' " _ ~ ~ i- <br />EPA Form 3320-1 (Rev. 3'991 Previous editions may be used T}11S IS 2 4-~3f1. COfTTI. PAQE ,OF <br />