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Form Approved. <br />FERMITTEE NAME/ADDRESS (hrMJr seWryN.nttoedlar (/n(Qi.errr) <br />' NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM /INPDESI <br />RGE MONIT <br />RE <br />ORT <br />OMR OMB No. 2040-0004 <br />NAME Ti"~Pf <br />E~ I`1I f~l :I: hl~, ~ RIG . ORING <br />P <br />~ <br />DISCHA <br />I ~ ~ iAiia~ <br />ADDRESS Ti~~it''F'~'~' i''131RE ~`. { SU~~i~ JG <br />~' • ~• ~~~ ~ ~~ PERMIT NUMBER DISCHMOE NUMBER ~ '" ~ r I~1~11-- ~~~~'~ <br />G~+$, T G C I~ ~? ~ ~r ~ a~,Ct33E `~•~11='l" T'~~;T 1 N® ~'I:'tC~ i:} A fl ~ <br />FACILITY Ti~~1F'i^'Ef2 i'~II~E MONITORING PERIOD <br />~ Y J3 D Y R D <br />Y ~ <br />, <br />' •#iF <br />a' <br />LOCATION~~~~~ C© IGic FROM .. TO c A ,#.. <br />;..~ <br />, 3~!Ci ~~aGt-~~G <br />-~t~E I,,,~I •:£ <br />PITTBt!: i~c^ttV'S~''ri.7i~I~Y G. IDt6J F3CD~5, P~E5106°~ NOTE: Read il»tructltxa br.tor~ compbtiny this ftxm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANALY~S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />1 <br />~~~~IOT?~,PH~?A SAMPLE <br />MEASUREMENT ~'~ iL~.r /Va / ~ ~ y ~ <br />T~I'1:~I3 ~ U (~ <PERMIT #ib~ ~, t_:. l ~ -~• ~ x . ~,i'- ~ ~.~_ ., `~ - <br />EF1= ~11E~1T GF2L~55 11~~~ REQUIREMENT ~:•-~•~~ htN ~•',~rL.lfiw GE~~)`i' <br />L. ~ <br />~ <br />' SAMPLE ,; ~: . - ~-•;~-~a: ~• <br />~ ' <br />~ <br />~ . •~.: -.t•~::-~ :.;:. ~ ~: ~,;, ~ <br />) <br />r <br />~~ <br />1EP1 3~L.~5 <br />P <br />16 MEASUREMENT , <br />/G <br />~ ~ ~/ <br />j <br />TAt'JbG 11 U 67 PERMIT xr 31•~~•u t. ~~ EFL- v i.. 'r t <br />EFF~.tJEN`I~ Gf3C)~aS WAI..."~ REQUIREMENT ~•~'~•il• i"IIV 'J/-~L_t~;r GE4'~7 <br /> SAMPLE <br /> MEASUREMENT <br /> F~ERMIT <br /> REQUIREMENT> <br />___. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />,:. _ <br /> SAMPLE <br /> MEASUREMENT <br /> ..;. . <br />.PERMIT <br /> R~tIU)REMEN'~_ <br />::::::::::........... . <br /> SAMPLE <br /> MEASUREMENT <br /> _,r'PERMIT <br /> REr3lliREM@N't` <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT <br /> RE(2UIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 ttnur u er Pena ly o I~w thal Ihb doeumenl n~ dl ett~clrmenb were <br />prtpared under my eirectlon orwperrglon In ~ceord~nee wuh ~ system desl`ned <br />TELEPHONE <br />DATE <br />~ <br />, <br />,/~ /~ t <br />/ <br />' to mars that qur,Mikd personnel properly plher rind erduete the in(ormr,llon <br />Sand on m <br />In <br />ui <br />of the <br />erson a <br />submllted <br />enoro who m~na <br />e th <br />t <br />m ~ <br />G , <br />/ <br />y ~ <br />~ ~Q ~ ~ <br />a ~Q~ ~ y <br />q <br />ry <br />. <br />p <br />p <br />` <br />e sys <br />e <br />, <br />l <br />lDk f I <br />"~ <br /> <br />~ <br />~ / ~ / <br />C` <br />f <br />y respoin <br />or those penoro direct <br />or ptherin5 the Infornullon, the Informellon <br />wDmllted h, to the Dnt of my knowkd~e end beHer, Wq necunte, and mmplele, <br />l <br />lll <br />1 <br />lh <br />t <br />ltl <br />h <br />f <br />D <br />l <br />tl <br />hb <br />I <br />f <br /> <br />810NAT'VRE OF F'RINgPAI EXECUTIVE ///~ <br />^~~ ~~~` Y7G <br />j <br />o ~ <br />/ <br />.°J~ <br />, <br />. En <br />nm awurt I <br />ert ere s <br />un <br />pem <br />nt <br />n <br />or su <br />m <br />l <br />n~ <br />e <br />n <br />onratlon, <br />TYPED OR PRINTED V Ineludlnt the possibility of ene and Implbonment for knowln`.Idtlloln OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRtrf~r~nctr sll ~ttachmtrnta htrr~/ <br />SEE ~. ~,. fir, Pty. b~-B, Ft3R Di~T1ATL..S OF" TEST t'~3tJCi=~IJ~E. REi•'Q€~ T L.G50 - ST~aT~ST~G~,L,. f~ ~©NT EST~~~i~; i ~ iRli-IIG6-d TS <br />t_ET~~i_ ~i"® 50l CIF TEST C31aGAt~IESi'75, t~rN~3 ATT~Gar°d AGt~TE T©?~~GZT`~ TEST i~EPC?i~T ~'#]~~'t T® %3f~~;. Ir~t~fE~l E~3ET TEaTIN~ i~iCIT <br />~( ~{°e iY') C141^" tfhi•~ T i'~~~~~'~~~~"` i5~ll'"Ee 14e~~ ~~{I~~~~ ~i~i~~°r~~• i'~ ~i'~i - - ,~}~~ <br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used. ~~"~, J~ ~~~FG R14_ pf~tTil. PAGE ~OF <br />