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PERMITTEE NAME/ADDRESS (/nrrL F.rwrylv../L«.nal t/1)IQ'w+ne) NATIONAL POLLUTANT OISCNAAOE ELIMINATION SYSTOM /INPDESI <br />NAME DISCHARGE MONITORING REPORT /OMR) <br />ADDRESS -.. <br />Diu.. .~v:•.-:: ~ ..~...ir... <br />. ti G X 1 ~+ ~ U PERMIT NUMBER DISCNAnoE NLIMeEn <br />_ ~ R i• i MONITORING PERIOD <br />FACILITY ~ I uy ~dU ~ ~ ii E 5 (:i~'F ti YEAR MO DAY YEAR MO DAY <br />L~T~ FROM TO <br />l'aLI::AVE- -- .. - - <br />Form Approved <br />OM8 Na 2040-000-' <br />(:;:1aFt l.s j <br />F - FII~Ai ! <br />1'v l: 1J 9 TC CCi.CcACC hltilre <br />i <br />NOTE: Read Imtrvctlo/w befwi Iso?npbtlnp this 1wm. <br />PARAMETER t]UANTITY OR LOADING QUALITY OR CONCENTRATION PJQ, FREOUENCV SAMPLE <br /> <br />EX of <br />TYPE <br /> ANiu.rsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : <br />' I: Y j r ! <br />1 b <br /> <br />` <br />REQUIREMENT <br /> <br />• • . J <br />~ <br /> ~ <br /> <br />' - SAMPLE <br /> MEASUREMENT <br /> PERMIT _ ,• ~ , n ;- <br />" REQUIREMENT <br /> ~, <br /> <br />J' SAMPLE <br /> MEASUREMENT <br />J c b• C r i G I_ / .. , <br /> REQUIREMENT r' <br /> <br /> <br />' SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT .. • .;~ . _ ., (; / ~., ~ ., '~ ~. i. / .. <br /> REQUIREMENT _ , <br /> <br /> SAMPLE <br />,I <br /> MEASUREMENT <br /> PERMIT - ~... ,, ~• 1, : ~ D _ F A C <br /> REQUIREMENT <br />,. <br /> <br />' -'~ ~ SAMPLE ~ <br /> MEASUREMENT <br />i <br />• <br />t ... : <br />. PERMIT r <br />Fl t ~ n - - <br />= 't <br />i r J T n <br />' - REOUIREMENT h <br />. <br />,, .,. <br />. <br /> <br /> <br />' SAMPLE <br /> MEASUREMENT <br /> <br />.. PERMIT ... - ~ ~ „ . .. 1' r.: - <br />REQUIREMENT <br /> <br />1 rtrt,l) a rr pen. I• n L. lh.l thN darv menl •nd dl •IlKh menu Overt <br />TELEPHONE <br />NAMElT1TLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />p~P~rb under m) dlrerllon or wper.hlan In e+ccord.ncr wllA • eniem edined <br />to teurt Ihel au.nned pennnnel properly ~elhrr end rr.lu.le the Infnrmellon <br />- --- <br />l <br />submilled. e..ee on m) InQu <br />r) of dx perwn or per»ru who mul.~e the f)slrm, <br />or Iho.e persom dlrecll) reepo,Mbir for plheAn~ Ue Informalon, the Infornrllon <br />f <br />k <br />l <br />h <br />h <br />b <br />fubmllled <br />. {o I <br />r <br />ell o <br />m) <br />wew <br />edFe end beMA, Iroe, nrcYnle..ld tompk/e. <br />wa <br />th.l lh <br />Nfkanl <br />mdlf <br />ubmlin <br />EIONATURE OF -RINCMAI EXECUTIVE <br />i ~ l <br />m <br />. <br />l <br />f <br />f <br />tee I <br />f <br />tlon - <br />~ ~ ~~ J <br /> o <br />e <br />n <br />rre <br />re. <br />E <br />p <br />a <br />ar r <br />nf <br />. <br />n <br />orm. <br />, <br />TYPED OR PRINTED InehrdllK the poeAblUt) of flnr.nd ImpMonmrnl for lno.InE .5d.llent OFFICER OR AUTNORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IR~f~r~nc• aAl ~tbehm~nts h~r~l <br />~ L4f1h 1:':L:. ~.lY • GY LPSI VL LUR J~ JU:]eJLL { 1V G4DLEl L, r <br />I - This is a 4- art form. PAGE of <br />EPA Form 3320-i (Rev 3~'~) Previous editions may be used. u L ~ p <br />