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Form Approved. <br />F£RMITiEE NAME/ADDRESS pweiYJ.F.eWryNaar/L«urar tJD(dinnr) <br />NAME ''"f~~t'PEf~ f'~:~f'JIf~G, ~E~If. <br />ADDRESS ~~~~~~~ ~~~~ <br />f'. O. ~CFX i87 <br />C1~~13 ~ C£~ G ~ hob <br />FACILITY # f~tAl'P1}~ M~hf~ <br />LOCATIONC}~vY~'~';~ ~f:J F~~.E}~~ <br />~"f"T'~l: R~•1Yi°ifwlflfl3 C. OU T~C~S~, 'f~~S.l~i~9 <br />NATIONAL POLLUTANT DISCMAROE ELIMINATION SYSTEM /INPDESI OMB No. 2040.0004 <br />DISCHARGE MONITORING REPORT /OMR) ~ ~ ~~~ <br />Cf.7EJQ3~•?: ~ 5 O~ 1 f=: (SUIil:7 JG > <br />PERMIT NUMBER wscNAROE NurweER ~ - F ~ ftif~L, f'iL~a~ ~+7 <br />MONITORING PERIOD ~Sir•f-it i"s~ ~: f"I~L7~L.E ~? Uf'~E GUL%d-f <br />YEA MO DAY YE MO DAY ---- <br />FROM f .~ tl Tp c: s z#~r•>;• l~tifCi I~ ~ ~~f-fa~t9~ f _„_ f •~••r•# <br />NOTE: R~~d Imtructitxa b~fw~ compl~tirW thb Corm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, mECUENCr <br />OF SAMPLE <br /> <br />P <br /> EX µ~y~y TY <br />E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(:a ~fr~~~ SAMPLE <br />MEASUREMENT '.fi••?`•it••ir3f-!:• <br />~ ( ~~})' ##d''##3-?- #ii•~••i>:•:f••!& ~ is•2:-•ic•tr#9:- <br />a <br />v~~ <br />~ ~ 3U~1f_ <br />I~~fCf~1u :~ ~} C} PERMIT ####3t•# f~~f'(JFt (' '. ~5=9 ~••~#+t•#-t, •iz~•3.#n-# •~•-tt-•~•3t~# ### _~.~L. b. ~--L7rif <br />i~~'i= f...i.)~f~7 GfdC3~S l~i"~)....U f;EnUIFiEMENY: 3 f~f~'?' M~+X f'JCI=:. t1 #### <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT <br /> RELIUIREMENT' <br />.............................. <br />................................ <br />............................ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,' <br /> REnUIREMENT' <br />.: .:. ._ <br /> SAMPLE <br /> MEASUREMENT <br /> __. <br />>"::PERMIT <br /> REtibtElV1l:NY` <br />:::::::.::...... . <br /> SAMPLE <br /> MEASUREMENT <br /> ........ <br />PERMIT <br /> iR~+luraEMEN'f' <br />_... <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> REQUIREMENT <br />;.:_ <br />_ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' cenuy u er pena ty o IaY. mat mia doavmcm and di attachmenb were <br />prepared under my direction or fupenhloe In accordance with ~ syatem desiSned TELEPHON E DATE <br />nn <br />~~~n ~ G i ~ ~ ~ D/ ~ to assort that quaHOed perwnnei properly Sather and eraluue the Informalhrn <br />submitted. based orY my Inquiry of the person or persoro who manaSe the system, ," <br />. <br /> or lhox peraoro directly responalbk for SalherlrtS me Information, the Inrormation - <br />S ~ ~ye~ <k ~ <br /> <br />GLVJ <br />auDmilted b, tome bal of my knowkdSe and belief, true, accunte, and complete. <br />1 am aware mat then are alSnltlnnt penaldo for auDmlttlnS hbe Inform^tbn <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~~~ '~' ~~~/ <br />!~ O~ ~ ~~ <br /> , <br />I <br />M <br />TYPED OR PRINTED r <br />udinS the paslDitity otOne and Impnaonment for knowlnS vldatloln .OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO OAY <br />COMMENTS AND EXPLANATION yr nnT vw~n 1 Ivlgs I/itrr~rmn sn imcnm~nrs ntrn) <br />~"~~ p.:t 3"'i,?~"t^-i3.. I~L}f\f L_~fvi~T~ WZZL. B~ ~~+Il)~FJr p~ ;?~~"~YT'b..~~~L'a-. SUL~I1u f...~['iIl"t-@I~P~.I~.3 F't:31~ 'r=~.C7Y~t ~?$#'fl'Z' P~I^~Ii-' ~4~)"f`dT•_ <br />~~~: ;~u4~af^I~ a~~ f'f~t~C)E~ FtEQUI~~f"i~f~lT;.z UI~~~~ r. ra. ~. T~~ f~fof~~~Ta~zly~ - ~. ~. ~. a~L. p: fa~~~~r= -- ~~~ ~. ~. ~. cf:~). <br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used. ~~3G3G ~ f.~~~~4-~3t'[,.f~rtp, PAGE ,~F <br />+~ `~' ~ <br />