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PERMITTEE NAME/ADDRESSp+.~irF.rwryN..rrer.rldrUD1D~++~•q <br />NAME <br />r <br />ADDRESS .~ ~ . __ . ~~ . . ,, ,, ~ ~ ..: ~ . ~. <br />~Uk 14.iU <br />.~AUi; +=G ~1~1c <br />FACILITY ;,1pL' Nud'iN v S~Uil (",1?~~S <br />LocwnoN >:~ a L I S d C'/' ~: u a l~~ a <br />-, .. . .. . . . r <br />NATIONAL POIIUTANT dSCNAROE ELIMINATION Sr3TEM NPDESI <br />DISCHARGE MONITORIN4 REPORT (D R) <br />PERMIT NUMBER dSCHAAOE Nl1MDER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040.0C04 <br />J ~. t3 !~ ~. it <br />F' - f'InAi <br />?l>111r ~ IC 4G?~L tFEEn <br />NOTE: R~~d Irntructior» b~for~ ~o?apl~tinp this twm. <br />PARAMETER pUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX of <br />PE <br /> ANALrsis TY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ , ; <br />' <br /> MEASUREMENT <br /> PERMIT t : <br />: - ~ ~ l ~ T ~ ~ ;: t <br /> REQUIREMENT . <br />_ <br />~ <br /> <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 OFFlCER ' """) " ' a"") or Lw Ihel IJ.h dncumenl .nd .u .n~cnrnenb Overt TELEPHONE DATE <br /> pRp~red under T) dlrectMn Or su prnhlon In octord~nn wllh • f)fltm darned <br /> to funure Ihel queNnW personnel Pr~~l [Nhtr end e•~luole the Inforwulbn <br />,ubmlued. e..ed on m) irpulr) o! IM person a persorre wno nt.n.xe /ht f)fum <br /> . <br />l <br />i <br />h <br />• Or Ihox penore d <br />rtcll) resporn <br />bk for ~el <br />erlnN Iht InfortMllon, lht Inforrrrlbn <br />~ ~ <br /> fubmilted If. b Iht bai of m) Ynowkd~e end belle(, Irve, ~ecvnu, end comple/e. <br />I em ewere tAet (hers ere fl~nlnnnl pmdtia for gDmlltb <br />ht: Inforrmtbn <br />tiIONATURE OF -RINCt-AL EXECUTIVE ~ .. <br /> ~ <br />, A A <br />TYpEp OR PRINTED lndudlnE the pawlhlul) of nne •nd Iniprlsonentnl for ttno•In~ •lolntbrrf. OFFICER OR AUTHORIZED AGENT NUMEiER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (R~l~r~nc• dl •ttachm~nts h~s~l <br />- , <br />:~i.. ..It Lc ..i - .. ... . • z • a.• <br />` EPA Form 3320-1 (Rev. 3/99) Previous editiorn may be used. , w l~ y 1 ~ , This`is a 1-part form. <br />