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pERMITTEE NAME/ADDRESSpwelrJriwerHryN~/Leearoel/Dylrrvnr)
<br />NAME ~'X;~~:.I6~ h'EtfiJ:i:~u~', i.. L..~:
<br />ADDRESS ~Faiil~Z~ti +U~ci~, '~ ~i"f; aC~(~. Ci":C~ik~'i
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<br />FACILITY ~!~,P~t%~C.•1~~)'4 f,;'°2f•~ f! ~,:;_{•~ r.'i'",i•~. i''i:tC"~~.t"s
<br />LOCATION C,,,"'[..f("f~('~~~~_) .'s~ ~;(.4i-~i~`t
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPOES/
<br />DISCHARGE MONITORING REPORT /OMR)
<br />PERMIT NUMBER DISCHARGE NUMDER
<br />MONITORING PERIOD
<br />YE R MO DAY YEA MO DAY
<br />FROM ; t t .L ~: t.t ~. Tp t.~ ~ •.:, s.
<br />Form Approved.
<br />OMB No. 2040-0004b
<br />C'i I tai{~i'd ,
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<br />NOTE: R~~d Imtructlofa b~for~ compbtinp thb town.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO,
<br />
<br />EX FREQUENCY
<br />of SAMPLE
<br /> ANALYSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />i.llL. !~t)~a~_i ~~r:ti'i~E SAMPLE .=;.;,.#,..~..;:s ( =•L#.~ :: #3r•'l-3t::- 3-'•5ri•s:••s?•:?• r•~•#•f,x.
<br />i,~ : t~'t1~ts_ MEASUREMENT
<br />w''~•':~~•t:; ~, ~ ~;:~ PERMIT> #3txtF#•~t R~PI~RT 'Y ~•a`=~ ~##-st•#~• #•si-3t•#~it #~•#•##~- t-3E;i•~t l~i_.~,~ 7._•{~'~~'t
<br />.i:'~~f...~_S:`:i~iT G`}~iJL~ ~r=~~.~.lx kEnUIRI:MENY Ifv~=,T MA?~ E~f!:~-mot=.> ~..~..~.:;~. ~#GNTi~
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> `PERMIT
<br /> REt1UiREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ?'PERMIT - - -- -- -
<br /> REt~UIREMENY
<br /> SAMPLE
<br /> MEASUREMENT
<br /> >PERMIT'< `
<br /> ~iEt2Ull#EMENT:~
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<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT!::
<br /> iR~nuIR~M~NT''
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMI'T`!` ;
<br /> f~E4UIREMENT>
<br />PRINCIPAL EXECUTIVE OFFICER ' """y ° er pero ty o ew thaat mb em~ment end .n ^ttrrttments were. TELEPHON E DATE
<br />NAME/TITLE prepsrad under my direction or supervision in secordsnn with • system desl6ned
<br /> to assure that
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<br />submitted. oared on mf Inquiry of the person or persons who msnsEe the system, .~,
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<br />~ or those persom directly respottsibk for lherinE the Infornulion, the Informstlon / ~
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<br />V submitted fs, to the bnt of m knowkd snd betlef, true, seeursle, snd mm kle.
<br />I sm sssure that (here sre sl
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<br />~ 81ONATURE OF PRINCIPAL E CUTiVE /
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<br />TYPED OR pR~~p indudint the posstDlllty of One end Imprisonment for knowln~ rlolsuoin. U OFFICER OR AIRHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXF'LANATIVN ur AnT vwl.n l tuns /fra~r~nc~ en ~racnmenra ntrr~)
<br />";~L, ., T~i7r'~L l: 3't"~ii'~# 1..Ii"is l°~ .'id.'__ I~Jr: L~1~1~~~1~, r=,i`•+~S 5~"~._:'~_~f-I;L~• w~i__:+:~l;=s i.~.h9f ;~'~C~;~i.•:I~:.=.i ~'i:i;~ --ti~y~t~~, ~',c#}-t~ ~~:~t:;1F~'
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<br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used. ()r~?,~ cif ,~ t:u~L~~'i~34-~?~~Qrm. PAGE ,OF
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