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PERMITTEE NAME/ADDRESS(/weYJrF~eWryN~w/Loe~„ow~/D(QGrnnq <br />NAME ••f-i''~~'a,~G"~f~ ~"f~fV7~Cr, Yj~C, <br />ADDRESS ~~`~~~~~ ib~Iitl~ <br />p. Q. ~O~ ~1:1~ <br />C~tf'-TG Cq 03fs~~ <br />FACILITY T•fd~IPsa~~$ ~~~~ <br />LOCATNNd C ~ ~ T G C CJ ~ ~ ~~ S <br />t"~T'l"~S: i~~tYE"10I'~lF~ G. E?U Tit~T~.~, I~f~~S/Oi'i <br />Farm Approved.. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM /INPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /OMRI j~ Z ~jQ~ <br />'~'3~.: ~ ~.. t'~t1~R JC <br />PERMIT NUMBER DISCHARGE NUMIER F - ~= I It'r,L ~IQT~ i~~ <br />MONITORING PERIOD <br />FROM Y D Y TO Y AR ~ D ### I~EJ O T SCI-~,~AFti'C`~' I~I . #~'c#• <br />NOTE: Road Irntructlaa batwa cam latin9 thla form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALY~s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE '~ °~''°'•'#' • `~' [ r~ <br /> MEASUREMENT <br /> <br /> <br />E~F'~.tJ~l'dl' GRASS t~~LU REQUIREMENT` #-1z•3~# t"1 T 1'~.1 T !"tlJ1''i 1"Ifi, ~ T h~t-IM ~,~-'!.1 <br />L_ i; SJ , lr ws SAMPLE ~ ,; •,: ~xi::: .. ,. ,. ~. •, •~• ~ - 7 <br />' ' - G:. <br /> MEASUREMENT -~~ ~~ <br />~)O~r~'•5 ~, t7 {3 PERMIT ~' . ~ •~ .; ~ ^ a '- <br />E''tI,~~Pa'tT GR~188 UC~~..U gEOtlliiEMENT <br />;:.. <br />_ i' <br />, #•ic## :~~~~,dl f1;1~ T'} 3:i_Y` ?~lX ;'~~../f... I~iC11~i" <br />_, 1,. ~ • ~ -~ .!^ SAMPLE x :'x 7s ~;:; ., R• er •,,: 5: • -::: .•x:.,-•,; •,c •,o <br /> MEASUREMENT <br />/ <br />OQ59`~ ~ O L3 E'<:RMIT rtrr: •>; #•~•~• - ylt <br />~t=~Ll.lfrfy {' ~:f~CJB~~• `+Is~~U <br />~ ~ REQUIREMENT: <br />_ <br />.. ~% # 4# ~ S1`~S f #`~#~zX f`if"/i.._ ~>` P3 I <br />, ~ <br />;.t L... <br />TI-$f~iS 3'R~ATi"fEf~T !;'L.~"II~f SAMPLE <br />MEASUREMENT i~ ~ ~~•:~,-x~: •r•~-,::~• .~ ~ .~.. <br /> ~ <br />'~00~0 ~ ~J O PERMIT ~ : _ ~ u• <.,p ~• : .-. •~ - #x# a.. ^~~.. .:~ <br />~~C' f_..~]/r~~. ~'Fi{~~5 ~fasle.,lJ4 REQIiIREMENT <br />' ::3f~:1~~~•/ ~'>~Ji> T L.'r', I`j?' f"J ~ #•~•## <br />~3. SAMPLE if ~t•:c# r x ti~ •:. ##•i"•~##• <br />57 T S'SE~I_t1~:t'3 MEASUREMENT <br /> <br />70~~'S .A 0 C1 PERMIT J ... .t•~{•>v^ ~ •a-# r, is,-at . -. <br />~ ~ ... ti <br />~1=i"L..~J~:a~1'E GR~S~ V~~Uk .R~t1U~a~MEN'F r #~~~• 3~~,~ <br />~~~~~. ~?~~,~ik=t rTx t~~~/~ <br />3 13 ~• ~Y ~; ,.~ SAMPLE •~.r~r~: -k 9.. 1 ~ .~. :.~.::::r .; is-.~. •tt•.ti...:-- •u• K• <br />i) T S~~1L MEASUREMENT <br /> <br />~~•O~Il3 ~ ~ O '':.:PERMIT ~v=~. ,•~•t=~•# i.. ~:~ ~ .,::a~, <br />1~~~'...t.IT=IU`I' GRC18S Ur~llw-..3 :REQUI~tEMEN'f` tV~'~' !'li~,)i ft#~Y=C #~•~_:- !`t~t~tTr• <br /> SAMPLE <br /> MEASUREMENT <br /> <'f~EpINiT <br /> REC2UIREMENT: <br />~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t <br />anrtr a er pens ly o law that fhb doeumem and dl attacbmenb were <br />prepared under m~ dlrectbn or superrMon In accordance wllh ^ system desl`ned r~~"~} TELEPHON E DATE <br /> <br />/~ ~ <br />qt~ <br />~ <br />~ / / , <br />to tenure IhN quaNled personnel Pr~HI Lather and eraluHe the InfonnaUon <br />submltled. lased on my Irpulry or the perwn or perwru who manate the syrlem, 9/6ti~2 <br />Q~ <br />, <br />~ <br />/t/t ~ <br />/„ /C tl <br />lM <br />th <br />dl <br />f <br />h <br />d 6 <br />, ~ roporo <br />or <br />ose penoro <br />ree <br />e <br />or ~al <br />e <br />,K Ibe Information, the Inrormatlon r~ <br />p <br />~ <br />/ (. ~ <br />C <br />/1 C7- submitted b, to the bnt of my knowkdNc and DeNef, true, attvnte, and mmpkte. <br />1 am swsne that (here are rl <br />nilunt <br />enaldn r <br />bmlttl <br />I <br />r <br />b <br />f <br />i <br />dIONATURE OF PIIINC~PAL EXECUTIVE ~(,i ~~~' ~~U~ ~ <br />j I„~ <br />. E <br />p <br />or m <br />nN <br />o <br />e <br />n <br />ormat <br />on, <br />TYPED OR PRINTED Includfn` the poglDilllr orllne and Imprlsortment for knowing rldaaom. OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION vF ANT vlvLA r Ions IRa/ar~nca sn •aacnmanrs nary/ <br />l-5S ~x T(~i-£~L Ii~~tkf l..il"dT~"S Rn~Tl..,l_ F~~ IkJAI~#f~g?, w aE'3'l`LEF~g3L~ SI'JIr.~OS ~~'f"t~l- ~PP~~;~•O 1="©~t ~.= ~.~i~'F~, ~~•i-t~ r~Ftf~CYP IE~I~€'~T- <br />s~~ ~uf~f~frf~ r~,~ f?~~of: r~f~~us~~~~~.~~~"~ u~+.~r=~ ~. ~. ~. ~~~s r~~®r~f~TO~~r+l~ - ~. ~. ~. r~~~. ~.~ ~f3f~~~~ - ~~~ ~. ~. ~.. c~a. <br />~ u a _ r n _ ca~rS ~n <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. s _ r ~ (j~j~'~ ~ f tr~~v~~~° Q`G~gI'til. PAGE ~OF' <br />