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FERMITTEE NAME/ADDRESS pwebl. F.eWryN../Lornow UD(0~9 <br />NAME ~-!~~):~C!1,>:} f"(~t`'~~~~5~'ra 1_.f_~~ <br /> <br />~1-~i~'~i~i!..fi`~~'~ ~•~SZl~'. Pt ~.i_..i~_ <br />ADDRESS <br />L..I~`r. f":~.Iti~.r_.i:.. <br />Jt 1~.1"{ 1 <br />~~ <br />L~. lei.,%~ <br />. <br />' <br />•~ <br />T <br />FACIIIIY ,~..r-~~i•:~j,.,t,(':( ~;{~. 3 •~t, _~t' t~ .I:'., i t~ 1~Y5 <br /> <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT /D R! <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />Y AR O.. D Y YEAR Q. D. Y. <br />FROM ' ' •`• - TO - ~ " •` <br />Form Approved. <br />pM6 No. 2040-0004 <br />t. {{ <br />f~, ~'~~' ~+~ l~ Tom. `t' i ~•~iU i"l..lli ij ~. ~': t'-'9 <br />I <br />NOTE: R~~d In~tructior» b~fw~ compbtlnS thb twm. <br />PARAMETER QUANTITY OR LOADING. QUALITY OR CONCENTRATION NO, FREOUENCr SAMPLE <br /> of <br /> EX ANKrsts TYPE <br /> AVERAGE. MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />!_1'-, wy .:, E i;,,: > ~ :i•~. tT,i, SAMPLE _~•:;• -= n >; ;~. .: .-; :a•,-::v-- i . s•,•-.: { ~.;_ <br />F' T CJi':::.E'Hf~VL.~~ =~ MEASUREMENT <br />' <br />; <br />~iv.~4t~ InI ~? >PERMIT ~ ., ~ ~.. ~~-:~ _v~ . } -~ .. , ,~. ,k°c;~.. I _ r ~ <r1~~ <br />~~'; ~L_fJl<.;~.~~~ t3~C?~;'`. err°',L~:r REQUIR~MEN1` :i•~•a:,: ~~N VAi_~+E: ~.i"~ ~- <br /> SAMPLE <br /> MEASUREMENT <br /> >:;;PERMIT ' _ <br /> ~tEQIIIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> .:PERMIT <br /> REQUIREMENTr <br />....................... . <br />................. .......... . <br />___ ___ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> RE(2UIREMEN`f <br />_. <br /> <br />~ <br /> SAMPLE - <br /> MEASUREMENT <br /> :PERMIT <br /> EtEI]111REMENT <br />..:.............. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT" <br /> REQUIREM~N'Y<' <br />.................... <br /> SAMPLE <br /> MEASUREMENT <br /> ;PERMIT <br /> AE(2UIREMENY <br />__ _ <br />__ <br />_ ___ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER t arhtr u er pem ty o kw (hst mb dotvment end dl etdchments weR <br />TELEPHON <br />E <br />DATE <br /> pneprrred under mf dlrectlon or super.Mon In oeeordona with ~ ryslem desi`ned <br />~^~'"' <br />~' /~ 1 G~ <br />i . <br />l~ <br />~ to llSYR Ihel goeNDed perwnnel properlf plher end ereluete the Infernulbn <br />submitted. Onsed on my Irpulry of the person or persoro who rruns`e the rystem ' <br />••---- <br />1 <br />/ <br />i <br />~ ~ , <br />or those penorn direetlf resporalbk for plherln` (he Information <br />the Informsllon '~rd. <br />- %: f ~ f ';~. <br />^~~ <br />,/ <br /> <br />~ <br />~ , <br />suhmltted b. (o the hest of my knowkdEe trod heNN <br />true <br />arconte <br />and mm kte ,. f.,r <br />l <br />7 <br />~ //J ~ <br />~ <br />~~ <br />~ <br /> <br />' <br />~ <br />r ~ <br />~Xi~~ ~~-''~ <br />~ , <br />, <br />, <br />. <br />I am aNlR Iha( IheR ^R d(nllltln( penaidtl fOr plhml(tln~ fabe information EIONATURE OF PRINCIPAL' EXECUTIVE ~ <br />~ <br />_~ I <br />~ ~ <br />( <br />, ~ _ <br />npEp OR PRINTED , <br />lndudin` the poadbiliry of One end Imprlaonmenl for knowln~ .Idatloln. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO OAY <br />COMMENTS AND EXPUnn~ I wn yr nnT vwt.A i ivns /Irtrrnmc~ m~ ~rfacnm~nfs nail <br />3:'c",i=:: x. ;~'x. •'~. r`t, 'r.,;a '.a"-+a.'1=C:~(~ L?:~~-'.Tr::CL.S C.T- TFS"4" I"-'C7C1t;:~i~a.f?~. ;z~"'->fi~;~t't ._`_.;5C7 ~_ z?'r'~i"I;-~l"l'~"~i_ F':;:r,1.~ '..i;-it~;i~T~ bJi-~I~9;°! <br /> I5 <br />-- ~ i ;~+'~L~ l"G r~~l G'~ "i'~5":' ~ ~I~ ~„~t•~.I ~~f~'~:, ~?1`~t~ t4~T`! ~~}Y r`?t~~ }'"?"L _rr«~X ;~ r° l TY .T:L'S~T i~~~Q~s ~' "r tl~;i~3 'i I" rI``I~. <br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used. { y{-•j r~ c;7 r~ r ~~~t~~~gt4r~T~[~ryp, PAGE 10F <br />