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PERMITTEE NAME/ADDRESS pweYMF.efbryN../Loenon Un10~•+n9 <br />NAME 4;?"~~i~c'~ i'I..r i~d J. ~~~, (....i_(: <br />ADDRESS r=""r,~t~~l.~~r~ fa~K~~ °t )...)r~, ~i'li~: I`i~.'s'~~::~ <br /> <br /> <br />FACIIiTY~~s:`-l'~~~~~i~4'a~ {~'r''< <°s: ~f..i~ {~~i-''t ("I.l~~t.~s <br />LOCATION ~~S"~~~•; a~`i ;« ~' ~ ~. ~;~•~ <br /> <br />Form Approved. <br />NATIONAL POLLUTANT aSCNMOE ELIMINATION SYSTEM- fNPOESI OMB No. 2040-0004p <br />DISCHARGE MONITORING REPORT /O RI ~;t ~j; ~~~,;~ <br />PERMIT NUMBER ascNARUE NuMeER 1<" --• ~ ,~ i'~a,-ii-.. ~t.~#`~a -~ <br />~,If41+ t-?e.3R',~?~"~" 7'C fi.s i~:~~, f.~";_It~.~'_1 i?:C4}t <br />MONITORING PERIOD <br />YEA MO DAY YEAR MO.. DAY <br />FROM t. 3.. ~. TO c. ~~'li'* i'`4ui Li.:£~~: ;:s~#-~t_-',"r I ~ i .I;..;~ ~. <br />NOTE: R~~d 11»tfucNtxa b~for~ compl~tin9 this fofm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCV <br />OF SAMPLE <br /> <br />YPE <br /> ANAlr~3 T <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />U:~1_ #~i~ ~°dEf3la.~. SAMPLE •~-xs_-~ir#i:.# r'~) xr<•~'-~~-63~ .~,.~..~..:~..Y:••k :~;,~#•+•ir-~: <br />~,,~ j ~R.J:~,j_ MEASUREMENT <br />`~~~~.?:fr~ .. ~ :.! <PERMIT> ~#~ -tt~.4~t _ ~~=3. tt ~ ###ii ~i•#### r •~•~ ~.-#~# ~:#•i , ~! v 1 .. Al. <br />;~.~'•~- ~_k)~€~•3T ;^~':~~s,~ ~1,~°~t_?: "L :ft~O:UIREMENT <br />........... ... Z iV~i7 t'1AX 1'~.'sCa=;1 I<..;:..r I~ikJ!'•~"TI <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> :~tEQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PIrRMIT <br /> REQUIREMENT: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMITi' <br /> REf1llIREMENT <br />::::.....:............... <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT'' <br /> REaUIREMENT>~ <br />............. . .. ........ <br />_ _ _ <br />__ <br /> SAMPLE <br /> MEASUREMENT <br /> !`PERMIT < <br /> REnuIREM~NT;' <br />.................... . <br /> SAMPLE <br /> MEASUREMENT <br /> tPERMIT " , <br /> REnUiR~MENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' «rtny ~ er pens p o Isw thsl Ihb document and dl tllschmenls were <br />prepared under my direetlon or super`Islon In oeeordanae with s system desl`ned TELEPHON E DATE <br />p Sr ~ <br />t~ <br />1 ~/ ( <br />Y to Gaon that qusNfled personnel PnPe~y Esther snd er~luste the Infornutlon <br />Based on m <br />In <br />ui <br />of the <br />submlNed <br />erson <br />h <br />n <br />th <br />t ~_ <br />- r <br />~ <br />y <br />VVV y <br />q <br />ry <br />. <br />p <br />or penoro w <br />a`e <br />o ma <br />e sys <br />em, <br />----- <br />"J <br />c+ <br />, <br />~ L~ ~~ ~ <br />~ . <br />`~ <br />/ } or throe noro dlnetl yes mfble for alherln the Inforsnall the Inforrrutlon <br />Pe 7 Po L t on, <br />~ <br />~ <br />P' , <br />• . <br />, I f ~ ~ ~" ~ L <br />~ <br />~ <br />~ <br />Q J ~~ <br />nr,~ r ~ / I/~ O / ~~/ ~, <br />I/ ~ submltled Is. to the best of my knowkd~e snd betlef, true, ttccunle, snd complete. <br />nlllunt <br />1 sm aware NN there an sl <br />endtles f <br />bmlttln <br />fsbe Info <br />utl <br />EIONATURE Of PRINCIPAL E ~ CUTIVE i ~L~ ~ <br />I ~ ~~- [_ f~ <br />TYPED ~ pR~y~p ~ <br />p <br />or su <br />e <br />rn <br />on, <br />InaudinE the possibility of nne and Imprlsonmenl for knowln~ vidatloln. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY vIVLA nvNS /R~f~r~nc~ sli ~rncnm~nrs n~nl <br />..~.~~ ~: IC1'!`F?4~. :i:~i-~C~i L.;C!'4iY' I~aa.L.i~. ~'I«' ~~e~~:`Yk:;:/, {~t~i~5 ~E~-?`?_~,'~~:;~~: <:i4:3s..~:~".~, r_-t.if f=frs!'~~-_~~~~.) t~'C~i=c :=~.C~`ti'i~r ~~'d~aY;tti ~"C~%'~..~:~-` <br /> a.~v~"~1`i~~ <br />. _ _. ~ . ,.h .~ . t ~.... ~... .z 1 e r t t (..: _' .- - ': i : ' L' r f ' i ' <br />~%~"4_.Cv,";~4_1. ~,;41L_~:L~'~i t_T!"f~:~- tr`~'s ~~~ t+l~'•~.C'~L_t; ~ v1,. "t~CsYF~,'~.•;f.f? ~, .__C+;'T--.'-t~~ :..,~,. '!, a <- f~.---_.,, ~„•~fli ~, ~~,. ~:.~, .+ ~I~f~ i-~.~=.:i•?h~i~'~~. <br />. • ,., . <br />._ :K ..amt. e t r i.. rt. c.. v , r-te ~~rt s_..:_. •. ~_,r < t _ ~,e.. ,r_...t _. .. .• r "': Y" PA <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. T,t}i~S-•l$ 8.4-A~t'[-fArln. .~F <br />