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PERMITTEE NAME/ADDRESSpr.atrbinrWryN../Lorrlarl/D~.r+nrl <br />NAME <br />ADDRESS .:J '. _ .... , ~ _ .. , : .. <br />11C~Y. l~I~U <br />.:aAU~ C <br />FAC1LiTY ~~ G r Cti G it'T ri L S G U T ii t. <br />LO(.AT10N !~ a L 1 S a 0 :. c <br />f 1 A: i L^ f G C 4 <br />NATIONK pOILUTAliT DISCHMOE EIIMiNA710N SYSTEM ((NPDE$l <br />DISCHARGE MONITORING REPORT (OMRI <br />PERMIT NUMBER gscHAROE NVMDER <br />~ ~ MONITORING PERIOD <br />I :r :. - YEAR MO DAY YEAR MO DAY <br />L ~. _ FROM TO <br />Form Approved <br />OMB Nc 2C40-0004 <br />r - ria>t!L , <br />~- <br />NOTE: R~~d k-~tructioi>. bt+iw~ C-xompl~tinp thl~ ilxm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FliEOUENCr SAMPLE <br /> OF <br /> EX ,wA~rsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' ~ F l• , I <br />~ - - - ~ =.'. <br /> REQUIREMENT . v , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER 1 «rol) u u pen• 1) 0 1^w u,l ihb dorvmem ^rd ^u •tt,cnmmu were TELEPHONE DATE <br />prtp^red under m) dlrtcllon or flrperrtflon In ^ccord^nce wllh , r)rlem dt,lened <br />le mart IhN au^Mntd prgonnei proptAr plAer ^nd erduUt Ihr Inferm,llon <br />^uhmllled. bsed on m) Inquiry or ihr per^on or per^oro whe m^n^~e the r)rlrm <br />, <br />er Iho^e ptnoro dl recd) re.ponelhk for [^IhrrlM Ine Inrorm^llon <br />IAe inform^tbn <br />. <br />^uf•mllled Ir <br />t <br />Iht belt of m <br />tnewkd <br />rd S <br />M <br />r <br />I ~ ~ <br />) <br />. <br />o <br />~t ^ <br />e <br />e <br />, <br />rLe, ^erunle. ^nd compkle. , <br />• I ,m ^w.rt uu Inrr< ^re d~nlnanl pen,ttla ror mhmlmn~ r.be Inrernrtlon <br />810NATURE OF /RINClPAI EXECUTIVE - <br />TYPED OR PRINTED , <br />Incfudint Ihr pomlDlGl) of not ^rd ImpA^onmenl for RnowlnE rld.tlolx OFFICER OR AUTHORIZED AGENT CODE NVMBER YEAR MO DAY <br />COMMENTS ANU C!'.r~./+nn,rvr~ ~.. r.... ....~.~„~,.~ <br />.. ... ~ - ..__. tn. ~• <br />I EPA Form 3320-1 (Rev. 3/99) Previous editiorrs may be used. Thu ~s a ~-part form. <br />