|
PERMITTEE NAME/ADDRESSpnrrtill.F.eWejNrw/Loeurall/D(QGrYllr)
<br />NAME CfE~;~~f:t R1T-~;.I:rd~.;, L.k..t.`
<br />ADDRESS ~alvS~Clf~i~f i,;,•~?j.~ ~: .tE (•'~ .~f~f't f`~7.(~1=~
<br />FACILITY ~fi,l:,}t~.C:1F?f~I r'>~~a t ~f__I~'. r1F~~`- f'~2XfV~'
<br />LOCI1T10N C~f`~~.:!? ~;~~ C: t~3 ~ i ~•;3~'
<br />fits`"i"hf: ,1~~swiC~~ '3'. GQf~I`'?~~:; ~~ fr:C. Vii, t~,
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI
<br />DISCHARGE MONITORING REPORT /D R)
<br />PERMIT NUMBER wscHARGE NuMeEn
<br />MONITORING PERIOD
<br />YEAR MO DAY Y R MO DAY
<br />FROM ~r -• `.I TO ~ 4` y
<br />Form Approved.
<br />OMB No. 2040-000~
<br />fv! ~ fVCii~
<br />T= ~= ~ hit~f_. filJy~l ~~
<br />NOTE: Rssd Instructions bslon complstinp this Corm.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO,
<br />
<br />EX FREauENCr
<br />of SAMPLE
<br /> ANALrsls TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />y .~~ ~., SAMPLE •~;- '~:~~: i ; ~6.: .:_'~•~;<-~-,~ 3>..-.,;,;G.~-~%• -~-#;t•~r••r
<br />,i ~~~• I_i,yL MEASUREMENT
<br />`3~~'ltaE! l) ~.~ `PERMIT ####it# R~Pl3f~~ ~~=-1 ###'kFii••k• ~•#•3F~##•~ '~-#a;#3<••~- r.lf:s: p.ir~/ T, IJ
<br />%=F'i= a ~.7t=.sd i C-f?C.f~;`:: ~ t;L.~_ik REQUIREMENT I N~~T f~!AX i~~~~t x~ r'..~. x. f'tE.i~tT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIY
<br /> ;REQUIREMENT
<br />_ _
<br /> SAMPLE
<br /> MEASUREMENT
<br /> a~ERM17 ):
<br /> REQUIREMENT
<br />..............................
<br />:.......:.:..::.:...::.:...:.:...
<br />.
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br /> REt1UIREMENT _ ,
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br />,,.
<br />.- , ~ ~-t~' ~`
<br />
<br />~-
<br />
<br />- x:
<br />1~~;'~r t - ~ - _` ~ '`_-
<br />
<br />
<br />F
<br />.
<br /> ~~13111Ft(:MiEtJT
<br />~~ `. ;~ r ;r t r. ,` ~ ~r
<br /> SAMPLE
<br /> MEASUREMENT
<br /> 'PERMIT ''_ _
<br /> REaUIkEMEN'f
<br /> SAMPLE
<br /> MEASUREMENT
<br /> 'f I:RMIT
<br /> REC]UIREMENT''
<br />
<br />TITLE PRINCIPAL EXECUTIVE OFFICER
<br />NAME 1 txrlllr Y f pent t] O lew lhal lhb document end tdt et4clllntnb weR
<br />TELEPHON
<br />E
<br />DATE
<br />/ pRp.Re weer mr dlRruon ormpervlslon in tleeord.nce trlth a system eesi`ned
<br />/ ~~G~,~
<br />J ~ :~ r ~ . to rmuR th.t queHfled personnel P~~7 6Hher .nd erduNe the Infornullon
<br />>,Ibmtted. s.eea on mr lllgmry of the person or pelsoro ono IIYn.te the syskm _
<br />•
<br />~ 4
<br /> ,
<br />h
<br />l
<br />dbk f t .
<br />/+-~~
<br />~ ~ ~ ~- .
<br />I ~'
<br />~ ~ `'
<br />~p
<br />~
<br /> or t
<br />trx persons direct
<br />y rtlpol
<br />or plher111E the Inforrrutlon, the Informellon ~~ - _
<br />j
<br />-
<br />d /
<br />~j 7
<br />I
<br />C ~ ~ ~ '/ ~ 1- P ~~~~ submlted b; to the btlt of m~ ktlowkd~e.nd belief, true, tleeurate, .nd mmpkle. y ~~t) 7 / ~ -. ~7 )1 {,,.
<br />V ' I .m.,r.R II1.I IheR .R !I(nlOpnl pe11.IHtl fOf lYbmlHn~ f.N! IMOTYIUOn EIONAILRE OF PRINgPAI EXECUTIVE
<br /> ,
<br />l
<br />l
<br />TYPEp OR PRINTED ne
<br />udin` the posibllitr of l-ne.nd ImpAsonlilenl for kllowlnE .loletloln OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />` COMMENTS AND EXPL.ANA I IUfV yr Any YWLA I IVIV.I I/flllfl/ICI sn IRICOTIA(7 nsitq
<br />p: a t j f~if_. ~l.tl i ~_. i ; I, t :a ~ r L.%.. }:~1~ feSIE`:.~ `v ~~.f, hhftfr% ~~ (~ i_ ~..f 7, ~_.~ '_iC~~ 1-~:'J }^.s'~ e" ~~.tCrt`:;... ~, I~~ r lnifl _ ' fi ~.i~'tt, ra ~ i`~~i
<br /> f ~: ~~ ~ i}•' ~il~~~I S i
<br />~ ~ -hog C'' ii J
<br />,ia.. o _.7~t~~,L. ~ '~;~L:C~i~ i....i:'€:f:`f'._, i~i^r•„ ~,I^ ,gin A{'t~'r
<br />4 ~-, ,r_%; t- I;r t. L !~'+ti' -~;`"
<br />t .?f~ :':i C~`~l2, r c•F-sn: t-,_t i- ~.~ ~:. ~i j ~
<br />{ l r_. ~" {: 'r ;7 [° ~" 'L i'
<br />.-r-fir, t`•~.. a. f~. _. ,=. s . t:)~ ~t~f'=,i~#T
<br />-• -,-~;~-; I,~~h~'t'7'li~?TIiJt:._~i=x= ~~.~~r ~)•r r. ~ ~~ c~ ;7~ ~~,-t~T,'i)L!'nf r j t,,t.~ ~k~Jfw '~~; _;.f~-,:.•-~° rinrv-rl^~1 ,r :xt~, I7f1~71~f>~~~ ~-~~~~n t~€=-~~°,
<br />EPA Form 3320-1 (Rev. 3~~) previous editions maybe used.. ~} ;~~ j, ~ J C!7?~1>~S~jS)~4-pQiIT1. PAGE •_QF
<br />
|