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PERMITTEE NAME/ADDRESSpwrLbF.eruryN../Ler.rtewl/DIQ6..nr) <br />NAME <br />ADDRESS ., _ _ _ _ .. .:• i .~ _ <br />~`JY 143u <br />_ :inl1G ~.1~ ~~l jt:fr <br />FACILITY <br />;10~ hUkTr: t+ ~GI,TH tyliii.:i <br />LOCATION i:tiL.LSAliE. ::G 8i5.:fs <br />r .. r r .• e _ er t. <br />NATIONAL pOILUTANT OISCHAROE EIIMtNAT10N SV9TEM //NPDESI <br />DISCHARGE MONITORINQ REPORT IDMRI <br />~- <br />PERMIT NUMBER tNSCHMOE NVMEER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />1 [~NL <br />11 TC c-C?.L Cki. <br />Form Approved <br />GMB No 2040-0OC4 <br />NOTE: Rrr~d k»trvctitxw b~tor• compl~tinp this tam. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FRE~UENCV SAMPLE <br /> <br />EX of <br />TYPE <br /> ANALY~s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ _ _ <br /> MEASUREMENT <br /> ~- FG ~. T '' • L i .J, r•. L <br /> REQUIREMENT <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 /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' rentq a rr pen• q o b. lhM tAH MrurrKwl •nd dl ^u.rnmenb .rre TELEPHONE DATE <br />pr<p.ned under rnt dlrect{on «fuperrNon In nteotd.ncr with . sJf1tM1 aefl~rrd <br />to ttavrr Ih.l qu.M ned ptronnel proprAr E.1Mr •nd e~NY.tt tM InG~tntHlon <br />uetnlu <br />etsed on m <br />t. <br />~tr <br />of tM <br />erwn « <br />a <br />r <br />o <br />wAo n <br />w <br />tM <br />t <br />m <br />, <br />p <br />s <br />e <br />. <br />r <br />y <br />p <br />n <br />to <br />u <br />.`e <br />t7s <br />r <br />, <br />~ <br />~ -- <br />' <br />«Ihoft prnote dlrrctlf rnponiWr f« E.tArrln~ Il1e In/orrrullon. IM Inrernrtlo~ - <br />~ <br />Yn <br />wYd <br />ltt <br />d F <br />t <br />lA <br />D <br />t or m <br />nd MM <br />t <br />t <br />D <br />r <br />d <br />kl <br />I ' > <br />~ <br />- <br />nt <br />e <br />s, <br />o <br />n <br />f <br />o <br />~r • <br />r <br />, <br />rue, nctvn <br />e. .n <br />romp <br />w <br />e <br />e. <br />fl <br />Nnnnt <br />endtr <br />f <br />f1ONATVRE Oi /RINCtrAI EXEClJT1VE <br />• 1 <br />tn.~ <br />re tA <br />t tAr <br />. <br />uDmtttl <br />hb <br />I <br />f <br />rn <br />tl <br />n ~ <br />J <br /> T <br />. <br />. <br />. <br />rr <br />rr <br />p <br />a <br />or. <br />n~ <br />e <br />n <br />o <br />u <br />o <br />, <br />TYPED ~ Pa11VTED Inrludin~ tM potelCllltf or nn..nd Itnprlfwtrnrnt r« kno.lnE vtd.llotn OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe%r~nce N/ •fhcAm~nta h~r~/ <br />... <br />- .. ,.. <br />EPA Form 3320-1 (Rev. 3/99) Previous edfions may be used This is a s-pan form. <br />•, _ <br />PAGE OF <br />