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PERMITTEE NAME/ADDRESS paeYJrfrtlhryN~Loeatow (/D(QWenr) <br />NAME Tt~~ll't'~R C'11fi~11'i~l~, ~i~1C. <br />ADDRESS Tl~ta,PI~~F$ ~~~~ <br />I'. O. ~4©k 1S7 <br />~~~~~ ca ~~ ~,~~ <br />FACILITY `}rRt~iI~P1~R I''~I~~ <br />LocATIDN C f~ ~, I ~ G C! S ? 6~ 5 <br />^-r-t~:,t• Pn~ynnatiaa7 r naa ~xn7~. Pa~~~sra~ <br />NATIONDISCNARGE MONI~TORIN~ REPORT ~DMRIPDESI <br />CQ~3Ca3~ 115 p(7a ~ <br />PERMIT NUMBER ascNAaoE Nt>titsER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ / - TO ~ a <br />Form Approved. <br />OMB No. 2040-0004 <br />r~ ~ ~vo~ <br />(Sl}~a~ .3C } <br />I~I~I~~ •~ ~~. ~ I~ u~~ ~~I~c~~ <br />~~~ itiCl T3~Sil-I~R~~ D~ ~~~ <br />NOTE: Reed irntrucdtxa beitxe compbtin9 thb 11xm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCr <br />OF SAMPLE <br /> EX TYPE <br /> ANAlrsts <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(~~~ :"'~IZ4L~ E~f:iEd•~S~ SAMPLE #•'.~'-i~::-tt,`i• L ~~}~ •~•ift*F#?~•~'r •i~'~::'ra.2•,"r~s• #•S:•rcn',~af••~- <br />V ~c~, v~gy~ MEASUREMENT <br />S~:•C7EsL-~ 1 {7 ~C) PERMIT -ik-~~~## l~~:f~G~tT ~5=~. ~-~~~1-~s-#,, ._---~-~~~~-~ .. <br />f __ ~~~ .~~fi•~ i1~6G~~'' 'a.~,t.Jr~~ <br />~~'I=L.L~~i~lT t9~CISS EI~'14,.~.1 REQUIREMENT` SI~IST 1`'tfifX ~~13=0 ~,_~ '~ •~~~~ 1`~G}tii~: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ,' <br /> REQUIREMENT.. <br /> SAMPLE <br /> MEASUREMENT t ~ <br /> <br /> .';PERMIT <br />j <br /> REQUIREMENT <br />~.. ! <br /> SAMPLE <br /> MEASUREMENT ~~ <br /> ',PERMI'9' ' <br /> R~auiaEMENY <br /> SAMPLE <br /> MEASUREMENT t{ <br /> >z«! PERMIT;;:;.:,,,,..:. <br /> . <br /> SAMPLE <br /> <br />MEASUREMENT ~ \ <br /> PERMIT <br /> a~QU~a~ME~rr <br />................ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> AE(lUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' et^'tY ° er pens tr o Isw that thb daavtttent n~ ul altschmenls were <br />errMon in n <br />ith a s <br />stem dad <br />ned <br />n <br />d <br />d <br />di <br />tl <br />d TELEPHONE DATE <br /> <br /> <br />/gg <br />~ ~ <br />~~ ~Q~ <br />(• y <br />t <br />on or sup <br />cmr <br />ce w <br />pstpase <br />un <br />er sn~ <br />rec <br />~ <br />to assure that qu~Nlled perronnel P~~7 ether ~M erdtsde the Infornullon <br />wbmitted. oaxd on mr Inquiry ottbe perwn or person who mnnate the rrrtrm, ~ <br />u' <br />On <br />~ <br />_ <br />f,P, or those penoro directly respomihle ror ptherlsst the Informstlon, the anfontataon // ~ <br />n <br />{/j/! ~ <br />q~ <br />Q ~ _ / ~~y~ r ~ <br />C= <br />' , ~ ~ <br />~ <br />wbmlltcd h, to the bnt oa my knowkdte snd beNef, true, xeurate, snd rnmplete. <br /> <br />OF FAINCIPAI EXECUTIVE ~~ ~ <br />~_ <br />~ <br />Q( 7 f(/ o <br />~ <br />~ S ~ 1 sm swue fAN there nre rltnl0dnt pendtln for whmlltint hHe Infontutlon, EIONATURE <br />TYPED OR PRINTED <br />Indudint the potdbliltr orllsse snd Imprisonment for knowlnt rldaUoiss. <br />OFFICER OR AUTHORIZED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANAI lVrv t/r nr~r vwt.r+ t wtva -retritrrtrnctr mi ~n~conr~nta ntrti <br />SS ~, TQTE~L 1~dC~ia! L.II"IITS €~#%!_L Y3~ v~'P,1~I~%3, gi S~TTL.~eRF~l..E: raQL~~3S LI~l~1 t~t~P@..T.~E~ F[7~ •~=1QYFd, ~~'r!"'!$3 E'~tEOT~" ~t1~iWT'" <br />S~~ ~(,1~~~~1 ~~ ~~~I~~ ~~~U ~ I~~.I•'3~~1 ~~ Ul~g~~~ ~ . a~. ~. ! ~W ~~I~~r TI~~ ~~~% "' ~ . ~. ~. <br />EPA Form 3320-1 (Rev. 3199) Previous editions maybe used. f,~(~ 1 ~n/Q'Y.~XI~~3~4-~}~i'Rl, rn~ie wr <br />