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PERMITTEE NAME/ADDRESS(IaaYJeParWryNaar/Loes+Honl/D(Qbrmr) <br />NAME ~~:;=.~i~};~ i'~? 1'~.! ~~~~ t_1... <br />ADDRESSk";41s~'.r~~~1~ ~~1~. ... ~)_.1ri `'F?'. l'i.i.('y~17 <br />1" L~. i;,.S',~ :era <br /> <br />FACILITY c^;,~r,1 ~~ 3.JF: i`I ~; ~ to t_: i~:L ;~`, +:.o i'' `•.P'b. t'l ~ f :I~~:i <br />LOCATION ~`ri'(~.1``.;i1* ~.. {;r ;,' ~.u.~ :?. <br />,~~',•~" 1»i~:. t.~~~1•``1 ~~':+ ~. ~.>~i.~1~~:: i~t ~t'i .;=ta ~%. %''. <br />NATIONAL POLLUTANT aSCHAROE ELIMINATION SYSTEM //NPDESI <br />DISCHARGE MONITORIN4 REPORT IDMR) <br />PERMIT NUMBER ascHAnaE NuMaEn <br />MONITORING PERIOD <br />YEAR MO DAY YEA MO DAY <br />FROM ;.., s i. r +., ± TO ... ~. ~ ~ .t. <br />Form Approved. <br />OMB No. 2040.0004+ <br />1~(S i~~raet <br />r ~; f~~` <br />u.. i~t-4 r <br />;~rl.~~+'t' Y'tl_?'~t~7t' P ~~_.i }~; r' )•x. 13 ~.?i`~E`~i ~ ~f_l~'+; ("{ <br />NOTE: Read Instructitxa b~tot~ cornpbtiny thle tom. <br />• PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREOUENCr SAMPLE <br /> OF <br /> EX µKrNS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />'~I I!_ f~i+4'?:~ C,i~.Cr'r:~~ SAMPLE •;.~>• ;c~.i #t•:~- .cr i ., :; ::-.~.;~.:x. ~•. r.i ~it•,r-i* .,, cJ~••:~-~r ::r <br />~` ~; ~_y~ s';~},.,, MEASUREMENT <br />~? At ~s ~,;e., ~ c~ ~ PERMIT >' #~s# # 3E• i`r 3t• f21- ~-~ „- c. ~-~ .. z~ ~ ~ ~ ~• ~t• ~s• •# # ~ ~ ~• •~• •?/ # # sF # F'~• -'E ~.- `d / , tJ F~ ~ <br />~~~''`.L!~~~f'i (''f?)~i~ 41~~,t_i_!t REt1UIREMENT <br />.:.:: ,: , It+i~~T t't~',X 1'~I>~=-C: •:~'~t•~.k r~~~•,TN <br /> SAMPLE <br /> MEASUREMENT <br /> >i:;PERMl7 <br /> "kEQUiREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> :PERMIT. <br /> RE(3UIREMENT <br />_::.:,. <br /> SAMPLE <br /> MEASUREMENT <br /> ::PERMIT 4 <br /> REt1UiREMEN'f <br />.......................... . <br />..... <br /> SAMPLE <br /> MEASUREMENT <br /> • PERMIT - <br />' <br /> iiEt]UIREMENT <br />::::................ . - ~ <br /> SAMPLE <br /> MEASUREMENT <br /> __.. __ <br />''PERMIT ': <br /> 'REC1UIaEM~N'C <br /> SAMPLE <br />-- <br /> MEASUREMENT <br /> PERMIT '' <br /> ~IEUUIRETvIENT< <br />NAME/TITLE PRINCIPAL EXECUTNE OFFlCER t «rmy u er pens ty o law tnat thb document and all attachmenU were <br />TELEPHONE <br />DATE <br /> prepared under m7 direction or aupervMon In aeeordann with a system des!`ned <br />c /` <br />~ ~ `.-Z'7 <br />; '- C _~ <br />. to assure thU quaHfled personnel properly plher and erdude the Information <br />submitted. 6aeed on my Inquiry of the person or penom who mana`e the system ` \ ~ i,... ~! ~ <br />"y' (L <br />.. <br />~ <br />,, , <br />th <br />di <br />tl <br />ibk f <br />h ~ i i i 1 I f # ~ ~~ ~t <br />/'' <br />`j or <br />ane penoro <br />rec <br />y respom <br />or pt <br />erin~ the Information, the Information f J /ji <br />` ^ <br />U <br /> <br />''~y~~ '/ Y ~r ~i~ / ~~ ~~ <br />//''~, I J <br />submitted h, W the !wt of my knowkdSe and beget, true, aceursle, and mmpkle. <br />I .m.w.R an meR .rr>tinlnnnt pen.mo r.r wbmtnns me inr.ren.uon <br /> <br />8 NATURE Of PRINCtPAI EXECUTIVE ~C <br />T F <br />~~ y` J ~ ~ Z <br />~j <br />~, <br />j <br />G~~ U <br />TMpED OR PRINTED , <br />ineludlnt the possibluiy of ene and Imprisonment for knowln~ eldaUo~ OFFICER OR AIJTHORiZED AGENT CODE NUMBER YEAR MO OAY <br />COMMENTS AND EXPLANATIVN yr nnT vlv~n nvNS /Refaenc~ M/ atticnm~nts h~rtrl <br />'.'~~ w~ lt.7T'r1i Tt';1i'~ ;._~:C~is"`: t°J1'f-.!._ ~~ 4~,~,1~-'~3~~ ~i1Ji) :°~~"}~st..~;~:r~1_.~ ~I:)f_':?.~~ L1~1"f ~t~'6~;.~:f~2~ F'~1~ ~::~~.t:;~Fa,~.:'~3-1h i'}t:1_~.~P ~'~'~.c#+1"1'; <br />)~~~'' t I..~:'~l~Yi..~ :atL~?i a i.~ I}~~;E "C #~~~°r` ~:?~:. l.,i~'iT {1L~r ~ ~.Ih' ~;•i ir'r ~ :, ;_•~3•s-#~ ~'v;:~i~tT'-53=~ ~!:. ~. ~: , Fr ~--C~, ~11`d)~ ~ ..~. r?: z~. 5 F'UfZ <br /> fi;Gt~li~`fiS. <br />-~Jc` i')~>~ ~ '~''7C-~ 't N:-r T=~' I~ ai-7 I ~i ~ ~ ;:~ c;: ti'F' ~+A'i s t"I>\I~'~} •t= :~;~ i r r~'~r ~:,~`~ry i' ~ F-3 t i"~!-I3=Wi`t' PdC hi i N °,: d=~'~,i =~ ~l fH2 '' htt•'~ <br /> !~ c~ r i !~~! i, ~i~ [;'1~L} <br />EPq Form 3320-1 (Rev. 3/99) Previous editions maybe used. ~~;.c'f.?nss,f s~}'p~~'~-~~a~t¢p~;.~{'O~, PAGE~OF <br />