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PERMITTEE NAME)ADDRESS pttesV4 iwrWry N../Lor,rr,w l/DrQb.wtr) <br />NAME <br />ADDRESS ~ _ <br />.J y iJ .. . ~J • I. V .. •r . ~ 1 .. ~ w. `. <br />..,i111~L C:U tli5ly <br />FACam <br />~1JL• ~Ud'1"ri b SOUTH Mth~~ <br />~~~ k~ALiSAllL i:U bl:,lb <br />_.. e v rnn c~ u u <br />NATIONAL FOILUTANT ascHAROE ELIMINATION Sr3TEM- JNPOESI <br />DISCHARGE MONITORING REPORT lO R) <br />PERMIT NUMBER ascl+AnOE Nt~+eEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />FMB No 204G000~ <br />(SJ6H L ~) <br />t" - FI1•AL <br />Pvl~G 5 iiC CL'b1 CfiEfK <br />'~~.c, <br />NOTE: Resd Imttuctitx>,e beforti 5°T`pleti~p thle fwm. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCr <br />of SAMPLE <br /> <br />TYPE <br /> ANAtrs+s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE [ <br /> MEASUREMENT <br /> PERMIT ~ .. ~ ", s Y `~ :: ; ~ U <br /> REQUIREMENT <br /> <br /> <br />'"' "- SAMPLE <br /> MEASUREMENT <br />- <br /> PERMIT _ , ~ , ~ .., <br />' REQUIREMENT - <br /> <br /> <br />- ~ SAMPLE ,, I <br />' MEASUREMENT <br /> PERMIT T -. ... x ,;. - .. - .- j ~ :, ~. <br /> REQUIREMENT <br /> SAMPLE <br />~ , <br />' - MEASUREMENT <br /> PERMIT - <br />..~ <br />---tv*rr.z. <br />.. <br />.t,, ~ <br />J <br />/ ... / .. .. <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />` PERMIT -. ,.. .... ~' ~ ., m _ ~ I :~ a is <br /> REQUIREMENT , <br />I <br />', <br /> <br />' ~ '• ~ ~, SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />' ~ v Y , <br /> REQUIREMENT <br /> <br />' ~ SAMPLE <br /> MEASUREMENT <br /> <br />- PERMIT ~ ~ c c" (.. ~ - ..r C b i i '[ .~ n !- <br /> REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECUTfVE OFFICER ' Ce^'tr ° r peo^ t, o b. lh,l 1hN documtnl ,nd Ni ut,chmentt were TELEPHONE DATE <br /> prep,red under rwe direction or wpen'ftlow In ,ccordente wllh . frrtem damned <br /> <br />- - to more Ih,l qu,NMd perwnnel ProW~7 [,Iher ,nd rr,ly,lt the Inrnrm,lbn <br />tubnrttee. s..ee on m~ Irputrr of the yenon or per,oru who ttun,Re the r7.tem, <br />- or (hoer penere directly reepond bk fa ~,theAn~ the Infortn,llon, tM Inkmm,tion -- ! ; ~j <br />r <br />~ wbMtted bti to the beet or mT tnowkd~e ,nd benef, true. twcvntr. ,nd comykte. ~. <br />- h <br />f <br />Jn <br />t <br />b <br />lt <br />f <br />I <br />d <br />l <br />f <br />b <br />I bIONATVRE OF -AINCNAL EXECUTIVE <br />i ~. -- .m ,w,n au t <br />p <br />on <br />pen <br />ere ^re f <br />t <br />a <br />or a <br />m <br />tln~ r, <br />e <br />n <br />erm,tlow, <br />TYPED ~ PRINTED Inritdtn~ the poeelDllitl or nne end Itnpr4,ontnem fw knowing .te4tlorri OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/erence eM ettechments here! <br />- _ . <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used TI115 IS H 4-P3R COML. PAGE OF <br />i <br />.. . <br />