Laserfiche WebLink
Form Approved. <br />P6RMITTEE NAME/ADDRESS pnebJrf~elbryN.w/Loeurerrl/D(Qlrranr) <br />NAME -f'F2t'~F'I''~F~' {~TI~iTI~IG, T'i°~iC. <br />ADDRESS Tl~s'~iFti~~~ IaiTl!?~ <br />f~. 0. B©~ ~ ~i <br />FACILITY 'I"{a~~l~~~ I"{~I`~~ <br />LOCATION C ~$ s~ ~ G` ~ ~ B ~. b ~ S <br />~TT~1: ~~-~'s`~'ICif~ls`? G. TAU F3®~'S, f't~~~fGP'1 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT IDMR) ~ ~ ~~~~ <br />C; C3t7~2 ~. ~ ~ 0 ~ 7 f~ { St113R •JC ? <br />PERMIT NUMBER DISCHARGE NUMBER p ~- ;:' X ~f~L f~iQFt`''tT <br />~FtJP.IC)r~ ~'fi~iTi~i~. L,!"f'~ '~-c"3 ~3~E~. GiJLCfi-I <br />MONITORING PERIOD <br />YE R MO DAY YE MO D Y <br />(~~ :t~''.f~ <br />FROM ~ ~ TO 3.c ~- A~~ ~•)~ I:l~,~rG~-i+~-1 Ptt~~ <br />NOTE: R~~d Ifntructiofu b~for~ compptinp Ihb torm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCV <br />of SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />FBI ~~ SAMPLE 5:•3~:;~~~€'~i7 ~~ } `~~'~ :•°~'~' 3Fi4~-:ril•# ~~ :Fi~s`r# <br />g ~U~L MEASUREMENT <br />E3~Q~~a ~. Q~ E~ >PERMIT af3F~,3E~,t-~t• _ ,~~.-I -sE•;~##-~~ *~~~k}.~~~~ ~.r~~~#~~ 1•~1~~~3!• ~.,:.i+~, Y '..,~~_.F?+. <br />~.~''F'i._U~'h!T C~`~OwS t/t~l..{1 itpOUIHEMENl' <br />................. Thl~ i' MA~~ i`~ICL:.(Z _-~-- -__ " ~~~ ; 3*•~'#~ <br /> SAMPLE ~- '~ <br /> MEASUREMENT <br /> '` PERMIT' <br /> REQUIREMENT <br /> _ _.... <br /> SAMPLE ~ ~ <br /> MEASUREMENT ~ <br /> PERMIT <br />REMEN <br />' <br />EIIU ~ \ <br /> T <br />> <br />I <br />R <br />.:...:.. <br />... <br /> SAMPLE ~ / <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT' J <br /> SAMPLE <br /> <br />MEASUREMENT % <br /> PERMIT '' ,.~'`f <br /> i~r:ouREM~Nt,' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> RE~il1IREMEN7' <br /> SAMPLE <br /> MEASUREMENT <br /> I<!ERMIT <br /> ~iEC2UIR[=MENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' "^"r ° er pena tr o law that th <br /> <br />prepared under m~ directbn or mp h document rand aft auaehmenh were <br /> <br />evrhlon In aeeordantt with • erftem derl`ned <br />TELEPHONE <br />DATE <br /> <br />/ ~^ <br />H o <br />' <br />to sawn that gwNtled perwnnel properly plher and erduate the Information ~ . <br />C.~ • <br />/~ <br />(,1 ~ /y+Ly ~ O <br />J submlNad. 6axd on mr Irpulry of the person or penom who num`e the syriem, <br /> or thox peramn dlreetl~ reeporolbk for plherlrt` the Information, the Information ~'~- 9 <br />~ <br />~ <br />~ to the best of mr knowkd~e and belief <br />wbmltted h <br />lute <br />amrnle <br />and rnmplele. ~U ^J <br />~ <br />)~C Y'- y ~O~ (/~ <br />G <br />'] <br />~ ~ ' , <br />, <br />, <br />, SIGNATURE OF PRINCIPAL EXECUTIVE ! j <br />l r 1 am aware that (here are >f~nlRnnt penalNn for mbtttittln` falx In(ortmtlon, <br />TYPED OR PRINTED Itrcludin` the poalDilitr of Rne and Imprlaonment for knowln~ riolatlom. OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /R~f~rtrnc~ sll att~chmtrnts h~r~/ <br />'~°S~ °< T~i"~t.. i~:~.;!*1 E..TI`~T',-S tL'~IW..~. ~~ !*JAT_5.~~:~, ~ 5~~"i'~.YI~~31_~ ~CIL'~T)~ ~..:ti~7't ~1PP1_,.'[„~~ FQR w-3.Q1./~, ~~+.I~~ ~'I,~C~:T~ Twtii~hli- <br />'~~:~ TiU~DE~3 f:l~' f~'RtgLF ~~~+UTFIEE~f:~i~;-f'a ~)NT7~Ft T. A. ~. 't'T)~ P1t1~lIT1*iRTl~l~ -°• T.I"3. ~. ~TL. « ~P.~t~,~~ - €.;T:~ T. T~. 3. (!~?. <br />' `.. x u , mss' r ~" w °~" ~.° ,. <br />EPA Form 3320-1 (Rev. 3199) Previous editions maybe used. ~Q~ ~ ~ ~ ~T~~3~4-~~f4rIT1. PAGE ~OF~ <br />r~ <br />