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pERMiTTEE NAME/ADDRESS ptwAJeF«WryNoer/(.oeorrorr (/DlpGrenr) <br />NAME 4..) :, ° ~ ~? L;I F'I ?' fi+t " ~'J } L_ I_..'.. <br />ADDRESS {'`r'i)'~.L~'"~)~I•~ ("-~r)~. ?t ~LI•~1 i...~{~'i t`~.l.i~:~';~1 <br /> <br /> <br />FACILITY .~~.5`-iI~~T.3t'..i)`C~~ >~hf{ ¢'. ~L..E~. '~~~•{ ~~.3ii)'~,,..i <br />OC <br />ATI <br />O <br />L <br />Nw[] <br />~'d~ <br />ky'a~ <br />f S".~.~°~.+=~ <br />C:t:.l <br />p <br />y <br />p <br />~ <br />( <br />^~ <br />'~ ~`'~ r' <br />y <br />i'D•f ~1V. i.1 C'?1'S~ ~ F ~+L.}L ~r ~F'{f ( <br />£ <br />$'.~i:: ~r ~r. }~. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPOES/ <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM L%! i. L: >,.t Tp tt , i r' ,..:.L <br />Form Approved. <br />OMB No. 2040-000~ <br />~_+t i:~' ii2-~ <br />~~:~I ej°?.~~ti~-i i~~~yt~ i.) f'!'•_i~~~ttt(?j~! ~;}~*T,'.Y'~ <br />NOTE: Road imtructiora baiwo compbtiny this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FRRrnuENCr SAMPLE <br /> ote <br /> EX ANALrst3 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />.~ I.... 'N"„`s~~ ~_~f^' ~C z;~i~ SAMPLE •F u.a..~ .t;..l;. r ~q. , -S •~: ~:..}..~ a; .: a:.k;. ,n:..r: •2r .I:_.,y.;:• .:-~•-:'• <br />+~+ ~ `:I~q~,~. MEASUREMENT <br />L•''-vi..~f~` ~ (_l < PERMIT,' '~'###'~•# R - !..?F.' ~~i=`:~, ~F ~ Y~# n•# -1? ~ •k~~ ?~# ~ # K-Y i%?t ' •i. •'r ~i• IV 'L / `,~- A <br />~:.::""i.._Ut I~. ~t~Ll:=~,-~ ~'Ai...J'` Ih~:J7 MAX h+}i;:t;:( <br />Y L' I"TEw1rJT: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMTl', <br /> :REQUIREMENT <br />__ <br /> SAMPLE <br /> MEASUREMENT <br /> `PERMIT <br /> REQUIREMENT,' <br /> SAMPLE <br /> MEASUREMENT <br /> _. ''PERMIT <br /> REOUIREMEN7 <br />:.:::..... .....:....:..... <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ''< <br /> REt~UIREMENT> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> itEQVIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> .'.PERMIT '' <br /> AEOUIREMENT'' <br />" <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER "^"~ ° er pen„ ty o law that fhb document rtnd HI rt[lrtehmentr were <br />' <br />TELEPHON <br />E <br />DATE <br /> prepsnd under my direction or auperrplon In ~ecordr,nce with • system desl`nM <br /> <br />t //~ <br />! <br />~ <br />~ <br />D > ~ <br />(7~ <br />° ~ <br />~ to more thN qusNOed personnel properly ether end erduete the Informsllon <br /> <br />submitted. based on my tnqulry of the person or persoro who menrtEe the system <br />''" ' <br />~~ <br />~f <br />. <br />, <br />. <br />. <br />" <br />./ ~ . <br />tl <br />th <br />di <br />dbk f <br />h <br />l <br />I ~~ , <br />- <br />" ~ +T- <br />- ~ ~ <br />~~l <br />" <br />'~ J"- <br />~ , <br />' y respor <br />or <br />ose persoro <br />rec <br />or pt <br />er <br />n` the <br />nfornution, the Information ~ ' <br />~ F <br />~ <br />t= <br />- / oaf/p '-~ <br />;t ~ • <br />i ~ J Z <br />N ~t <br />~" `1 ~ ~ i = <br /> <br />,~ <br />J ~ <br />/ fT i I <br />submitted b;, to the best of my knowkd~e end beNef, Irve, accunte, and complete. <br />1 am aware That then an sl~nlllnnt penaltla for aubmlttln <br />hbe information <br /> <br />EIONATVRE OF PRINCIPAL EXECUTIVE <br />! ~ <br />" <br />, <br />. <br />f / ,- <br />n(pEp tNi PRINTED { <br />, <br />induain` the poraiDiiity of nne and Imprisonment for knowing rlolatbrn. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPUNA71oN yr nnT vw~n I Ives /Ktrnr~nc~ sn ~rracnrnenra nnq <br />'i ut] ~ "? ,'1 Tv~A t T ""'.°n ! i T <br /> <br />1i_"i. L. a .C?i' (_:k{i i h L.~. <br />:.! ~}~~~' . ).` <br /> <br />!~~; 1ndi~ ~~~"„ r'tfil `:,~:r'C .; t, t~`• 1C" '1. j. .~'. '_. - ~."t4 ~ ..}:tf-3f ': <br /> <br />~_~'r-.i:,~..1. :~•.!w_:1:£.,.~ i_~"~ i.,,a~L.i-:,.~ ~-i3ri z=-:t, !~,~ _ . <br /> <br />F'F::r~;1.'-' ~S~~{`~Ti <br />iw: t ~~..~~'.?~~; I~~: =~~..)I.... ~~~~Ci ~~~"S ? ~ fi*~;~~~i <br />.. <br />.... <br />M ).:t i.: 'P7 i9tT'•~):.~ t~~~~ ..~'( {..?~'rrfYt ~~~"~~'a ~.'H'~ ~~ i `.~.5~~ .~ , ?fit. .L t ~'}~' ~~i-`.''= . F~;`*{~ ~ Vii. _~. t`' <br /> <br />~. • e, <br />. <br />. <br />-, <br />- <br />• •.,. t <br />, . r C r~..~'~~'~, i:t;!a.i'`~i'c ~L . <br />+ <br />...- +. ....... '* " r <br />.L /Y T ~./6._ r ; <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. C.. y2' .., i"t i_.. G„.. V <br />t <br />. <br />. <br />l.(`~f Lr .q <br />. ... .... <br />., <br />...This-is.a,4-par4fQrm. <br />s si.;) t~} ~~; ~ 1, ;_~ T~.J't~ t~ ~i `_ ~. ~r : ~ -r r <br />... . <br />.. %rG ' <br />