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PERMITTEE NAME/ADDRE55 (/nd.4 fw•WryNw/LxN+on 1/DIOG•n+J <br />NAME <br />ADDRESS _ ., . _ .~ .. _ . _ . <br />~~K 14 ~U <br />.:a;tU~ l:U tlt. <br />FACIIfTY i L' ~ '.r 0 !t 'T N b ~ G U l ti :1 i v c. <br />LOCATION L~ A L i J A .: ~ C L b l .~. <br />NATIONAL POLLUTANT aSCNAROE ELIMINATION SYSTEM //NPOfSI <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER ascNAROE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO , <br />i I 1 ~~ V Ll <br />r - FIhAI <br />E'Utrli lI TC i;CAI CnEE,IS <br />Form Aporo•.ed <br />OMB Pao 2040-0004 <br />a_ %~ <br />NOTE: R~~d Imtructiw+~ b~tw~ dorrtpl~tirtp this form. <br /> <br />PARAMETER ,~ <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO_ <br />FREQUENCY <br />of <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT - ::, ;, :: '.` ~ i . <br /> REQUIREMENT <br />• <br /> ~ <br /> SAMPLE ! , <br /> MEASUREMENT <br /> PERMIT - ~ . it n t <br /> REQUIREMENT <br />7 V <br />` <br />A ' <br />t.. •~ <br /> . <br />J <br /> SAMPLE . <br /> MEASUREMENT <br /> PERMIT a>afi~M~ :r '.:~ ._ • i '~ ~ / i~ n <br /> REQUIREMENT i i Y :' 1. :' ~ ~~ ; I. <br />,,, SAMPLE <br /> <br />I MEASUREMENT <br /> <br /> PERMIT , .. ., . .. i r. , -. . ~. X~ ~ `; ,; G ! l~ Q Q / r I_ <br /> REQUIREMENT j <br />;; <br />Y ~ 'AIL : v i. <br /> ~ <br />r. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .-.. i• :. i' 1: i:: 1 ~' F. ~: <br /> REQUIREMENT I ,••, j T ~! n r ~ '• <br />_ _ _ <br />+ SAMPLE , <br /> MEASUREMENT <br />.. PERMIT ai;rOr <br />. r <br />l:Gh'i - .._::LT iA~.,: <br /> . , <br />. <br /> REQUIREMENT ~ ~, ~ ~, .y , ~ l L Y C 7 <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT ..; ~'ChT t!E~C 'T :: i.1 v.,d <br />REQUIREMENT r; ;, y ':: ,~ ;i i ~. C A f. <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER ' fQ11I' ° of pe""~ ° ~'~ meimh d!>n.menl ^ne .n •ttrahmenu were TELEPHONE <br />prepared ender m~ dlrectton or super+t/on In .[cord.nce wllA . s7atem dalSned DATE <br />to avure IhH 4ueNfled personnel P+uW~1 L.I her end e..lu.le IM Infornutlon <br />tobmltled. Bred on mr InQulr~ of Nee person or persons who m.n.~e the s)strm, <br />orelbk roe E.cher+n <br />the tnforsrut/ow <br />the lnforirrUon ~ - <br />oro dlreeU <br />res <br />- <br />~ o <br />(h <br />e <br />y <br />p <br />{ <br />, <br />, <br />r <br />ose p <br />n <br />- - <br />t <br />f <br />t <br />wl <br />d <br />d b <br />T <br />lN <br />M <br />r <br />l <br />d <br />~ <br />' ~ <br />~ <br />m7 <br />ne <br />e <br />~e sn <br />rue, sKCVn <br />e, •n <br />tomp <br />submllied Is. to the be <br />o <br />e <br />e <br />, <br />e. _ <br />{IONATURE Of /RINCIPAL EXE ClJT1VE <br />'- .- <br /> I.in ew.re that (here .re fl~rJflc.nl pen.INe for wrbmllNn~ f.be Informetlon. <br />TYPED ~ PRIfVTED Includln~ the podDlutr of Nne snd I~npr4sonrnent roe knowln~ .id.tlosn OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO OAY <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS IR~fer~nc• s// •tt+.cAm~nts n~r~/ <br />., 1, . _ . _.... _ - _.. ., .. n . .. . <br />I EPA Form 3320-1 (Rev 3 99) Pre~~ous editions may be used <br />IF. ~vLnL ccc~s, sun~ECZ Tu SLEL <br />CO n v : ; This is a d-pan forrn. <br /> <br />