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PERMITTEE NAME/ADDRESSQneririetlrgN~./L«.rron~nlpG.,nrq <br />NAME <br />ADDRESS <br />Jilh : •~,i:S <br />,>_ISi~DE Ct <br />FACILfTY r'~~~~~,Uk NGF~'I~H $t SOUTH M. <br />L~,~ _~ i~ PALISADE Ct <br />iVF.LSDtV L- KID~~ERr V, N. <br />NATIONAL pOIIUTANT gSCMMOE ELIMINATI6N SY3TEM NPDE.S/ <br />DISCHARGE MONITORINO REPORT (D RI <br />PERMIT NUMBER ascHA~nE NuMeEa <br />MONITORING PERIOD <br />YEAR MO DAY Y AR MO DAY. <br />FROM TO <br />Form Approved. <br />oMS No zoao-oooa <br />~' <br />NOTE: Read kutruetltxw b~fo~~ eumpbth-p thh 1wrn. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N~• FRE ouF !Cr SAMPLE <br /> <br /> EX ANA~rsts TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />,.. _ REQUIREMENT e•i '~(i ' ' ~~ ~,~- ~: h? . . <br />' SAMPLE <br />- MEASUREMENT <br /> ;:, <br /> PERMIT <br />' <br />' <br /> REQUIREMENT r :r~:'t r <br />;'~<, I?r <br />~rI!-Y t~1~: <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT ~C)L~r' hi,v, <br />. •. <br /> SAMPLE <br /> MEASUREMENT <br /> ~ _ <br /> PERMIT <br />t:.. <br />' r ' <br />REQUIREMENT ~' =,'<< <br />- (~ - ~ ~ r ~. (,„ , <br />- [ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />:. L~ P i `: PERMIT <br />REQUIREMENT <br />,- <br />- <br />,~ _ <br /> SAMPLE <br />~~ c.~L `J=:: MEASUREMENT <br /> <br />~c.•.; r - - <br />~~'- ~ PERMIT r r <br />:?F2": R AL 6 <br />C3RTR hiN X <br />~~:- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ..~~ ~#-. <br />PERMIT <br />~ ~, .~ f4 <br />R <br />N <br />~., <br />EQUIREME <br />T <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER ' e'r"'~ " ' °'""~ ° '. th.t uy doevrtr"t .ne .u "t.thmenls .een r TELEPHONE DATE <br />prep^ree ^ttder m~ eirecuon « super.Hon In .eeord.nce +lth . s7sterrt eesl`ned <br />to sun Ihet qu.Mfled prnonnel yroyr+ll ptMr ^nd es.io^te the In/orrrution <br />' - ~ `' .y~. ~`~ ,~. <br />ltt <br />b <br />d <br />D <br />i <br />wr <br />m <br />e <br />. <br />tsM nn tn~ Inqu <br />ry e<tM persmt « penero .he m^n^p the system. - - <br />- <br />nr Ihtrse pence dlreclly responlbie f« ylheelrK the Informellow, the InfonnetMn _ - ~/~ <br />i(' 1 ., ~ <br />~ ~ " ' subn <br />ltt <br />d I <br />b th <br />b <br />t of m <br />Yw <br />wl <br />d <br />t <br />e <br />s, <br />es <br />y <br />e <br />e <br />e <br />te ^ne btNef, true, ^rcu nte. sne cotnpkle. <br />I ^m.".n U.t thrre en dFrone.nt pen^Itln r«.rbn,ltnn <br />r.tie Inrornenon <br />EIONATL1gE OF rRINCIPAL EXECtJTTVE <br /> ~ <br />, <br />I <br />f <br />r n <br />I <br />TYPED OR PRINTED ne <br />odirK the posslbmty o <br />ne.nd <br />tnpr+>nnmem r« -no.lni .Id.thrns. OFFICER OA AUTHORIZED AOEIET CODE NuMEiER YEAR MO DAY <br />COMMENTS AND EXPIANA I Igry_vr nnT vlv~~ I wns IR~rerenn M •fr~cnm~nrs ntei~l '!1 <br />- <br />:iUSP E^dDEL~ .; . ! DS (TSS) . TDTI^-,! <br />I EPA Form 3320.1 (Rev 3199) Previous editions may be used. t)OC) =' ~ ~ --'~ttS'~i9 ~ S-paT1 form PAGE OF <br />