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Form Approved. <br />PERMITTEE NAME/ADDRESS prw~rleFu~INryNwt/Loeurow I/D(Qlrnnr) <br />NAME ~'RAi'P'~~d I~iIN~t~IC~, ~i~3G. <br />ADDRESS Ti~:~I~~'EF2 ~'itC<!I~ <br />P. Q. ~SQ~ i87' <br />GI~~`,TO Cif C~31L:t2er <br />FACILITY 7~dA~'P~f~;F~j~l~ <br />LOCATION C Ft ~ ~ C; ~ C3 ~ ? ~~ ~ <br />s.~`-rnl• K3 r3ViVIPih1Yi ~ 49I1 Y~("}T4. p57~QlC'~h+l <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM_ fNPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /O R) ~,~~ ~ ~Il7R i <br />COOt]:3~ ~. i 5 O f ~' A d ~t.1BEs' .r`C 3 <br />PERMIT NUMBER wscNARDE NuMeEa ~" -- ~- S ~+il~L ~~~~~''T <br />I:s?~aut-1~~ T~ 1 LE.9fi`!~ (~"t1i...C~-f <br />MONITORING PERIOD <br />YEAR MO DAY YEA MO DAY ~ <br />FROM •~ t• TO ' c. ._, w ### ~.1~3 ~) i ~CH~IF~G~~ I ### <br />NOTE: Read IrNtructiom b~fw~ comPMtiny this ttxm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />of SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />A~~ SAMPLE ##3F##•'~ i ~Q•) ~:•~F:6~3'.~?;# -Ef•~#~k## :frg##:~# <br />~ I SUAL MEASUREMENT . <br />8w"~C?faEa 1 C? Q PERMIT -~s~#?r## FtE:PC3FtT' 1~~=1 sf:~•?t~t-## ~-'st•~t•#~# st~;a~:~#ix rr•~-:~# .~l~.L_• Z~~_,t~:,~ <br />EF1~"L~.1~P~fT GI~Q55 VP+f-.l1 REt1UIREMENI' II~tSZ' h'tAX t+lQ.-~'3 ~'#~'i~' <br /> SAMPLE <br /> <br />MEASUREMENT _ <br />_ --- __ __ <br />~ <br /> <br /> > ;PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ts~RIVIfT <br /> REt1UIFiEMEN7 / ~, ~' <br /> SAMPLE -' <br /> MEASUREMENT <br /> .;:::PERMIT <br /> REQUIREMENT --~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ,~ <br /> REOUIREMENt` <br />...:.....::::............ <br /> SAMPLE <br /> MEASUREMENT <br /> PER MIT. <br /> Rr+QUa~~+~rnr <br />........................... <br /> SAMPLE <br /> MEASUREMENT <br /> ''PERMIT <br /> REQUIREMENT< <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER t ecrtu7 u er pena ty o I.w thu th <br />dl <br />ibn <br />r w <br />d <br />d b document .nd .u .tt.cltmenu were <br />errMon In .e <br />dmce with . s <br />tem de.l <br />ned <br />o f' TELEPHONE DATE <br />/~ /"~ <br />/L L i G ~ ~ ~j //IR /S <br />' p <br />[ <br />un <br />rcc <br />o <br />p <br />r <br />prtp.re <br />er my <br />c <br />to more 1hN qu.NOed personnel P~d7 6ather.nd er.hute the Inforrrwtlon <br />aubmltled. 6.sed on mr Inquiry or the person or penoro who m.m[e the system, <br />,~ <br />i <br />Ca/~ or thox penoro direttl~ raporolbk for pthtrln[ the Inform.tlon, the Infornutlon `~-/~ <br />^ ~~ <br />~~ <br />~ <br /> <br />~ whmitted Is, to the best or m~ knowkd[e end belief, true, .ccurate, .nd complete. <br />IGNATURE OF PRINCIPAL EXECtlTIVE / <br />(/ ~ <br />~ <br />G <br />//l r <br />S . Q/1 <br />~ ' 1 em ewve thN there ae sl[nlllunt pmdtle for wbmltNn[ fabe Informetbn, S <br />TYPED OR PRINTED v Ineludln[ the pomlbllity of flne.ml Imprlaonment rw knowln` rlol.Uom. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION vF ANY vtvLa I Ives /Raatrnc~ sii •rncnm~nrs n~r~i <br />TSa ~,. 'i-I::xl`~1L ~P~E1N LIE~:~'T'~a 6.I:1'LL. L3>= t"IAIVEI'r ~ ~~T~"K_.~c~T31_.~ S©LI?~~ L~i~t~~ APPLT~13 '~'©R <~=IOY~, ~~Mf~ PR~t :~~' ~"J~I~i'I'- <br />S~~ ~LJivD~~~1 ~'~ ~'i~gOF 4~~t113~:€~EII°'i~t~aT'S U~I~?~~ I. ,~. 2. SAS f''tCl3VITCl~31\!C' - I. ~. r'. t~IL ~< ~>~I~ASE - SE;~:. :~. Ti. }.. t:l~). <br />~.~ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. ~~ rte, ~ ~~ ~T~S~~4-~~.~Yiltl. PAGE ,-QF <br />a <br />