Laserfiche WebLink
PERMITTEE NAME/AODRESSpwei~4F.rWryX../Lx.now(1DIQi.wv) <br />NAME <br />. <br />ADDRESS _ _ .. ., .. _ ., ... <br />. BUT lµ~U <br />.:inUE. ~(. 01:11 <br />FACIIfTY .~iDG hOt:TN t; `il;J7Y irilh~~ <br />~ocAT1oN t'ALI~AGE (:G o~Sl' <br />.. ..~Jt~ L. !CIGUsb. /.I . <br />Form Approved. <br />NAT10NAl POILUTAHT DISCHARGE ELIMINATION SYSTEM /INPDESI OMB No 2040-0004 <br />DISCHARGE MONITORINt] REPORT (OMR) <br />i . 'J C it L rt <br />PERMIT NUMBER dscHAROE N(1MiER F ~ ;, : ~ p E , <br />MONITORING PERIOD • <br />YEAR MO DAY YEAR MO DAY ~-r <br />FROM TO _ ,~', <br />NOTE: R~~d {n~trvetior» b~1or~ compl~tin9 this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREOUENCr SAMPLE <br /> of <br /> EX 'ul'r'LY~S TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE I , <br /> MEASUREMENT ' <br />_ ,. PERMIT , is F :' ri i i ~ _ ,. _ J j ~ L k <br /> REQUIREMENT ~ ;~ ~ Z M ~, ;. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <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 /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 nrtar u er pen^ t) o I,+ Ihst fhb dntvmtnl •nd ,II NIKh.nrnb wrn <br />NAME/'fiTLE PRINCIPAL EXECUTIVE OFflCER <br />TELEPHONE <br />DATE <br />Pnp,red under m7 dlrectton or wyer.f>fon In ,ceord,nn wilA . rptrm dal[nrd <br />. to aan Ihst qu,M M1ed prnontxl PrDPr~l [,thrr snd r•,lu,tr the Inrnrwutbn ' <br />,ubmrttrd. Fred on mr leputry or Ute Penon or peniom who msngr the rntem, <br />or (hose prnons dlrrclir reypordbk for [,Ihrrln[ Ue Informsllon, thr Inforw+,tlon ~ ~ ~ __ - <br />to hntlltrd b <br />to the Eest or m <br />tnew4d <br />l <br />d A <br />p <br />r <br />I <br />d <br />~ <br />, <br />~ <br />.. <br />[e •n <br />r <br />e <br />, <br />rvr, ,ccv n <br />r, ^n <br />tomPlrlr. <br />I .m ,w.r. u,t mere ,n tl[ntnc,nt pen,ltle ror wbmltnn[ r.br tnrornutbn <br />iIONATVRE OF MINCMAI EXECUTIVE a-. <br />TYPED OR PRINTED , <br />InAuNn[ thr psahntry or nne.nd ImPrlsontnenl ror tno.tn[ wd.nan OFFICER OR AUTHORIZED AoEHT CODE HUMBER YEAR MO DAY <br />COMMENTS AND EXPLI~ryA I Ivn yr ~n r vtv~n t tuna Irrlrrtrr~nc• sn •rr~cnmtrnrs nlrr~) <br />EPA Form 3320-1 (Rev. 3 99) Previous editions may be used This is a 4-part form PAGE Of <br />