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FERMITTEE NAME/ADDRESS n~••j•~nH-~~Nr~ uDfe~••nr~ NATIONK POLLUTANT OISCHMOE ELIMINATON SYSTEM /NPDESJ <br />NAME DISCHARGE MONITORING REPORT /O RI <br />ADDRESS ,_ ~ ~.-I. r .': 1 ' <br />Ii~X ~$3 PERMIT NUMBER ascHMOENVMSEII <br />~ A MONITORING PERIOD <br />FACILITY ~ NO ~ ~ j f~Et YEAR MO DAY YEAR MO DAY <br />LOCATION ; ~ CO ~ 1 [E FROM TO <br />Form Approved. <br />OMB No 2040.0004 <br />F - F I i~tAL <br />Sf?, DI-E~'' 7F?I._ DTC DfY UNMi~ TF?IF' <br />NOTE: R~~d k»truetlor» b~ftx~ compl~tl~p thb ftxm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, fREOVENCY <br />OF SAMPLE <br /> EX TYPE <br /> ,yf,~Y~s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,, .: ~- :: ;. , .: _ : '! ' <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> , <br /> PERMIT .: a~ 3~ ~ R # ., <br />I <br /> REQUIREMENT l iGI <br />_ SAMPLE <br /> MEASUREMENT <br />r~ PERMIT ##.k ~~.,tt. ~ ,. ~ ,: ,. _ <br />;)E~ REQUIREMENT . , _:..i: ; ; <br /> SAMPLE <br />_ MEASUREMENT <br />_ PERMIT ##~.~*i•#{~ ->~#-#'. ~~F## _. `~ 1r~ _ _ •.r-,~~ <br /> REQUIREMENT ': r' / hzx i~;: ' <br /> SAMPLE .. ... , <br /> MEASUREIv~ENT <br /> PERMIT t~#;~ .;<.~.;~~. ~i ~ ~ '~ ! . <br />- <br />/,. REQUIREMENT ;;'( ;'tAX C'- . <br />; .l (; _ SAMPLE ~ >, i->-;_s _ <br />~~-, MEASUREMENT <br /> PERMIT F? ..~~ni., _:i:~'C1RT _ ,.. ~ - . <br />. ,~ ~,', REQUIREMENT ~ :~, - -, I LY I'IX <br /> SAMPLE _ .- <br /> MEASUREMENT • <br />PERMIT ~:-. .: y:. ;~~-,r - ;r -x' ¢~: a :. , ~ . L. <br />AEOUIREMENT <br />AMElTITLE PRINCIPAL EXECUTIVE OFFICER ' er""r " pe""] ° 1iw u.l ahh e«„1nrnt .nd ^II ^1(Kh111rn11 ~fR TELEPHONE DATE <br />N <br />prsp^nrd coder iw] dlrrctbn «lupenhlon In Kcord^nsr »IIA ^ ^]ltetn darned <br />to Itsure th^t av^nMd personnel Pr~PrH] L^IMr ^nd r•^lu^tr IM Inferm^tbn <br />wrbmlllyd. 6rsed oa m] Inquln of tM person « prrlorr ~Ao nun^te tM ^vtteln. <br />or thole prrsa~ dl rsctl] rnporoll+M f°r ~^thrrtn~ Ur Inform^non, the Inlorm^tlon _ <br />; •` <br />wbmlllyd b4 to the belt of m] kn°wYd~e ^rW benef, Iroe, KYU n/r. ^nd tornpkle. <br />- <br />liIONATVRE OF -RINCIF'AL EXECtJT1VE <br />kf <br />r <br />bnrtnn <br />r <br />I <br />J <br />e <br />r <br /> or.r <br />i <br />I .rn ^..rt th^t triers ^re t <br />(rJnr^nl pen^ <br />a <br />. <br />.r <br />n <br />oren^tlon, A A <br />TYPED ~ PRINTED InAudIM tM po^e1619t] of nor .rid ImpMonrnent l« bno.lni .tot.tloret OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Of ANIf VIOLA I IONS I/t~llPrtrnC• M •ll~Cnm~nra ntrrtrl <br />., ., _ ~NR PRECIP EVENT I5 CLAIMEn. IF CLAIM APPROVED RY WQCG <br />~,_: ,_, , _ ~ wt_~ ;;~~ i. ~ ;,. _ ._ ~.~ ; ._ -- '' MEASUREMENTS--SEE i . A. 3, F'P 4-5 FOR BURDEN OF PRC70F <br />- . ,. <br />. <br />EPA Form 33?0-1 (Re~~ 3.991 Previous editions maybe used TIIlS 15 a 4-Pats COrrn. PAGE <br />