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PERMITTEE NAME/AppRESS pwaYii~eihyN~./Loealow yDIQb.,w~q <br />NAME <br />ADDRESS <br />-~ 1 J ~ .; ~1 .. ., r .. J l .. .. a .~ i. r <br />• DUX yvjv <br />aA/L l,C ni~L <br />FACILITY <br />LOCATION .;iUl tadR'Th L SirUT~' .,iht,~ <br />- ~~i.LrNIJL ~.~ CIISL <br />... - u <br />NATIONAL VOLLUTANT DISCHARGE ELIMINATION SY4TEM NPDESI <br />DISCHARGE MONITORINQ REPORT (O RI <br />PERMIT NUMBER D15CNAROE NLMADER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM t TO _ <br />Form Approved <br />FMB Ne ?040-0004 <br />~= <br />1 :~ 1, 1 <br />~ I~ CGLCh~~C <br />NOTE: Reid Inetructlorn beiw~ c~mpletlnp ihb ftxm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREOUENCr SAMPLE <br /> <br />EX OF <br /> ANAlys,s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br />~ <br />~ L Y <br />h :; 1 .: ~_ <br /> REQUIREMENT <br /> M 4 <br /> <br />" SAMPLE <br />' <br /> MEASUREMENT <br /> <br /> <br />` PERMIT <br />REQUIREMENT <br />- - <br />~~ ~ -. / <br /> <br /> <br />' SAMPLE - <br /> MEASUREMENT <br /> PERMIT <br />~ <br /> REQUIREMENT - <br /> h <br /> <br />' SAMPLE <br />~ <br /> MEASUREMENT <br /> <br />' <br /> <br />` PERMIT <br />- .. <br />• .. _ „ <br />i ." <br />:. ~ E / <br />_ ,. _. <br /> REQUIREMENT ti 4 • T <br /> SAMPLE <br />' ' <br /> MEASUREMENT <br /> PERMIT - ,{:. c ~ ,:T ~'; C ; '; i A : r p. <br /> REQUIREMENT <br /> .. , ,~ . <br /> <br />' ~ ~ SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ,•. ; <br />, t L n T ~ - - ~ :.. r: L y .~ ~ '~ ~ ; <br />- REQUIREMENT _ <br /> <br /> <br />~ SAMPLE _ : ~ <br />' MEASUREMENT <br /> <br />. '~ C ;~ t ~ F t`. t i I~ i. Y k ^ n <br />REOU REMENT <br />4 <br />- <br />documr"t uW dl •n.chmrnu were TELEPHONE <br />NAMElf1TLE PRINCIPAL EXECUTIVE OFFICER ' crnur . rr prn. t~ ° law m~i Ih~a DATE <br />pre p.red under m~ dlrect{on or auprr.Mon In rrcord.nce ~Ith . a)atem dgl[nrd <br />to asurt IhM qu.tlfled prrsonnN proprrfl [ether .nd r~.lu.le Ihr Infnrmallon <br />anbmltted. fiord on mr Inquiry or Ihr Prnon or penoru mho Iru".[e IM .)Slrm. <br />' er Ihuar prntrm directlJ reapordbtr for [.IhMrK the Infonrullon, the Inforrrrllnn <br />:' <br />wbmilted bl, to the beat of m~ -no~ird[e .nd betlef, Irvr. .ccvntr. •nd compktr. / ~ <br />1 •m •..are IA.t then rre y[Nnr.nt prndt{ea f°r submlttln[ r.l. {nr°rm•t{on <br />810HATVRE OF -RINCNAI EXEfalT1VE <br />npEp OR PRINTED . <br />inrh.dtn[ the poaa{nuu. °r nnr .nd Impn«,n.„r°t r°r kM,.in[ .i°+.u°M OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANA 1 wn u~ ~nT vlv~r, i funs (Iftt/~r~nctl M •rrrcnmmr~ n~r~) <br />1 ... -- . _ r - _ ...~ • • e <br />I EPA Form 3320.1 (Rev 399) Previous editions may be used- T}11S IS 8 ~-p2fl fOrT11. <br />... ;/L <br />