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FERMITTEE NAME/ADDRE55pwei~iF~rWryN../Locrrenl/D(Q(rnnq <br />NAME <br />ADDRESS , . _ _. - _ -.. _ _ _ ~ ~ _ <br />uUX 1~+.1U <br />_ ~AU1r trU tl151u <br />FACarrv ,,IUr. NUt1tl t ~CUTh r;il:~~ <br />~oc.A TION F' e± L I 5 A J 6 is G ti 1 S l b <br />- .,.. r f nncc. v u <br />Form Approved. <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION Sr3TEM //NPDESI OMB No 2040-0004 <br />DISCHARGE MONITORING REPORT /OMRI <br />.. :iii L N~ <br />PERMIT NUMBER DISCHMOE NUMDER - } i ~. % i C E <br />;, <br />MONITORING PERIOD ~ - - ~ • <br />YEAR MO DAY YEAR MO DAY <br />FROM TO I ~C I <br />NOTE: Reed Imtruetiaw b~1a~ g61~r pl~tln9 this fam. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FAEOUfNCV <br />of SAMPLE <br /> <br />TYPE <br /> ~yf~r~s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i t. 11 ~ h 5 1'i <br /> REOUIREMEN7 '- <br /> <br /> <br />r SAMPLE <br /> MEASUREMENT <br /> <br />• PERMIT , . - / - . .a '- <br />- <br /> REQUIREMENT ! ~. , r '+ ~ r. ~ L- ti - • <br />. ~-• - <br />SAMPLE <br />{ <br /> MEASUREMENT <br /> PERMIT - - ., it :. r ~ i' i '• (:. / _ !i n L <br /> <br />~ REQUIREMENT :, n 1 L Y I' • " L 'dl Z tl <br /> <br />~ SAMPLE , <br />_ MEASUREMENT <br />~%+-~ ~) <br />~ ~' PERMIT -. _ - -• _ ', l 1 iv J n 1 C k ~ :. r•, <br /> REQUIREMENT , +: is ~+ i i Y f X h C t~'i <br /> SAMPLE ( <br /> MEASUREMENT <br /> PERMIT n .''.1: C i. , ~ ~ ~i ~ ' <br /> REQUIREMENT 1 ~ ~ ( , ' <br /> SAMPLE ( -: ~ <br /> MEASUREMENT <br />1 PERMIT <br />REQUIREMENT ..„t ... i.. 06~P <br />r ~ : I?~:. ~ ..' <br />. t, ` ., t ! ; I ~ ~. ~•. _ Y 'f X •• <br />„~ r SAMPLE <br />i~: MEASUREMENT <br /> PERMIT • ~ Er,r. " ..:, F _ . :, i r. r <br /> REQUIREMENT <br />- n y U _ ,'!' ; . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ur <br />' """~'" `r P`"„' ° to"'h,i <br />prepped under rnr dire<rlon of wp t+d°r°n""t "'d '° ""`bnr`"t. ""` <br />rrvhlon In .ccord.nce wllh . ,refem ddEned TELEPHONE DATE <br />.-- <br />- - to more rh.l qu.Nned pcnonnrl ProprAl ~.rMr .M r..lu.lr IM Inrorm.llon <br />sobmllled. tl~ed on mr Inquiry of IM pereon a penoru who rron.te lM .Tflrm• <br />' <br />- <br />' <br /> a those prnom dlrtcllT re+pornibk fa plMrlrK the Infonrutlon, the Inforrmtbn ~..i- ' - <br />~ <br />~ ` - <br />~ <br />~ <br />- wbmllred hti to Ihr bear of m7 knewkd~e end beMef. Tree, ertvnte. end complete. <br />nlflnnl <br />I em ewere Uel th <br />r <br />l <br />dtle <br />fo <br />b <br />lRln <br />hbe Informetl 810NATURE OF /RINCIPAL EXECVTiVE ~ r ~ '-, <br /> ere ^ <br />e s <br />E <br />pm <br />s <br />r w <br />m <br />~ <br />on• <br />TYPED ~ PRU~ITED Inrh,dlnt IM posnlbllltf or enr end Imprtsonmenl for 4nowln~ .Idetlor.>, OFFICER OR AU7HORIZEO AOEKT cooE NUMEiER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IR~l~r~nc• tpN •ttachmtrnta h~r~l <br />.~ ~.J i it .... .~ • _, ~ .. _ • .. • .. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions mey be used. TfIfS IS 8 ~-PBft fOf <br />