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PERMITTEE NAME/ADDRESS p^eMlr FuW y N.w.rLorulw 1/D(Eirwrr) <br />NAME `t'Fd!•~~'PE:f'i ~'iIl"~II~3G, ~I~IC. <br />ADDRESS ~~~~~~~ )y111~~ <br />Ct~t~~G rd OS.b~b. <br />FACILITY '~E~~1~(3~E~ dv1~IM)~ <br />LocATaNGR~,IG QCI €si6~5 <br />?.~'1"'T'RI• i~Adi'~it'ifii17 a~ ~tJ it~fiTc",, CJF?~.r-~/Cib'i <br />- _ .. .. _ <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR/ ~ ~ ~~~ <br />CCIC3L73~? 1 ~ L72~ ~-~ t aU:{2C3 ~C ) <br />PERMIT NUMBER ascH~ROE NuMaER ~' - ~= 1 f~}~6~ <br />X? I ~~M,~RQ~ TC3 I?~~L Qk14...C3-i <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY ~~ <br />FROM °«~ t s TO .t c .t 3c~k•# I~?Ct D ~ SCI-~Ai~Q~ +1'\I! •~'~~' <br />NOTE: R+~d Irntrucdofa b+fore compl+tinp thle fofm. <br />I"IQF~17 <br />PARAMETER QUANTITY OR LOADING 4UALITY OR CONCENTRATION NO, FREOUENCr <br />of SAMPLE <br />- EX TYPE <br /> ANALrsis <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />I7 ~I~~AtSE SAMPLE #•##~•## Z 5'~?~) ####~•# ##•z~•### ##,`~•~••~••Ii• <br />~ ~ ~u~y~.. MEASUREMENT <br />~--'I•Q66 1 `J Q >PERMIT #•I: ~--'r-si # f~E~ (~F~ T ' ~L;.=~ ~ #~•#i#-~,~ ; •~ •3~•~i-•r~•>f •~• ~•+'-•~•~i.~ ' ~E#i;• "+IQ~ f ~ I `,~?_?fit, <br />EFFL.U~9~1T G~dD~S '~J~L_U - R~t1UIR~MENT' I i~~~"t' #`'1:~ X S~IC1=Q ~ •~ •~~• MC)l~S s 4• <br /> SAMPLE ~--""~~~ <br /> MEASUREMENT <br /> PERMIT. ~ <br /> itEQUIREMENT <br /> SAMPLE <br />MEASUREMENT f <br />I <br />~~ <br /> PERMIT /' /~ ~~` <br /> RE(lUIREMENT>, ~~ ~ ~ <br /> SAMPLE 1 <br /> MEASUREMENT <br /> <br />' PERMIT <br />,. _ <br />~ <br />~ <br /> REtiUIREMEN7 ~' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~'~ <br /> R~~IIIREMr_N'7` ~ <br /> SAMPLE I <br /> MEASUREMENT <br /> PERM17 <br /> <br />;~~GUIfi~M..EN7'' <br />~~ ~ <br /> SAMPLE ~~~ <br /> MEASUREMENT <br /> p~AMIT' "' <br /> AEi]UIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' etf1"y ° er pens ty o kw that Ihb doeumeM and NI atlachmenb were <br />ervklon In <br />with a s <br />stem desl <br />ned <br />dan <br />d <br />dl <br />tb <br />d { /f TELEPHONE DATE <br /> y <br />` <br />n or aup <br />aecor <br />n <br />prepare <br />un <br />er my <br />rec / <br />~ ~ <br />/~ ~ <br />a <br />~ <br />- <br />S to more that quaHned perwnrud PruPed7 bather and erduafe the Informalon <br />based on my inquiry of the person or person who manage the system <br />submitted M~~~~~~'^r ^Y"" /t~~~ <br />~ <br /> <br /> <br />~~ . <br />j <br />..>Q/ <br />G~ <br />~ ~~~ , <br />. <br />or those persoro directly rnpomlbk for plherlrt` the Information, the Information . <br />/! <br />~~ ~ <br />~ ~ ~ <br />~~ ~ ' submitted h, to the but of my knowkdFe and Deaef, lne, aceunte, and eompkle. <br />PRINCIPAL EXECUTIVE 9~V ~j~Y - ~7 ~/ ~~ / /, <br />/ <br />• ~ ° <br />' 1 am .ware IhH there an sl~ninun/ penaltln for submitan{ hlse Information, EIONATURE OF <br />TYPED OR PRINTED Indudln` the posdDlltty of nne and Impriwnmenl for knowln~ violaUom. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO OAY <br />COMMENTS AND EXPLANATION Ot ANr vw~A I Ivrvs I/'fen/ence +n +rr+cnm+n/a n+r+~ <br />~"~S °< `i"Q"d"t'~L, TFt©it4 L~i"I~l"S l~d~L.~. I3E ~dA+IV~'~3, P~ ~~TT~..E~~31_-~ ~OL~QS t_:!°~I1" APF'I.~I~1~ ~'C3f~ •~==~UVF2, ~td•$-il~ f'~"d~;T~' ~VE9'~1~'-~- <br />;ti~~~' €~t.~~I~EI~! Q~' P~t;3CtF" I~~Qt~~6~Et';'i~i~~"~ (.~Ii1I'j~~t ~. ~. 2. 7'QS I~l"ll'.IITL'3t; I{~G -•- ?:. I3. 2. <br />~)Of~'OlQT~6CII:~l~R34 ~aform. ,~ Q"/~' <br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used. ,}~~ji,~~ p~~~}' PAGE OF ~--•~ <br />