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PERMITTEE NAME)ADDRESS pwrbJrFraYlrryNawrarLoenrw IfD(Qirenr) <br />NAME T~~,PP~R 1I~'N~1~3(~: ~l~~. <br />ADDRESS TRt~E'P~R ~~~~)~ <br />4 I~i~P. tS 1.+~ 4..7 L4.lG~ <br />FACILITY TR~,FI~'~~ i~lll~f~ <br />LOCATIONCF~f=AIC CQ E3~.4rr~~ <br />~2'FTIi!• I~d~YMf IPrIIl t _ I'Y(1 T$Ci s ~. E~F?rS/tANi <br />_ - <br />Form Approved. i <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT fOMR) Pi ~ ~([I~ <br />coQQW~~ ~~ Q~~ ~ c~u~~ ,.~c } <br />PERMIT NUMBER wscHAROENUMBEa F _ F IC~I~I_. ha"~I"~•a~i' 'i <br />1~T~CHf~~G)~ TV IA#~~T e~l~~~~ uU#...Ct-i <br />MONITORING PERIOD <br />YEAR MO DAY YEA MO DAY <br />FROM br.t Tp ~ ~~. #•~~` f+ICi I'i~SCNA[~T~ I~I •'si~~•# <br />NOTE: Rsad It»trucHola b~ttx~ complytiny thl~ town. ~~ <br />PARAMETER QUANTITY OR LOADING 4UALITY OR CONCENTRATION Np, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALY~S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />Ot~~~51~ SAMPLE #-~:-?t#~•# ( ~3•~ } ~-#~i-#3i•i!• ~-#~:~~~-'~ #-~##?b-'.#• <br />~ ~ c..a~1AL. MEASUREMENT <br />L~~l.}~b }. Q O >PERMIT #####-;f ~'£ .T ~ ~5=1 ###~'st•~•~• -~•~•-~•~••s!•~ #~~~--~••~- ~F#~- ~:;_~ v~=~,;.h~t <br />~fiF"i...k.J f~lT GFdQ~S S/l~l_.tJ~ REOUIFiEMENT" IN~T ~1~X i~4E)~() #ryF#~~ ~tt}<<~?"~- <br /> SAMPLE <br /> MEASUREMENT <br />~. <br /> PERMIT CM__~--- ~. <br /> I~EQUiREMENT <br /> . i <br /> SAMPLE <br /> <br />MEASUREMENT / <br /> PERMIT ~ j <br /> REQUIREMENT, <br />~ <br /> SAMPLE / ,~ <br /> MEASUREMENT ~ <br />C/ <br /> `PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> :.PERMIT ' ~.-= <br />" <br /> R~:DUia~MENrt`> j <br /> SAMPLE / <br />r <br /> MEASUREMENT <br /> .: 'PERMIT <br /> ~~OUIHEMEN7' <br />................. <br /> SAMPLE <br /> MEASUREMENT <br /> '::PERMIT <br /> REC1UiREMENT <br />__ <br />...... ............ ......... <br />. _ ...... <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' "^"y ° er pena ty o aw thu [hb doeumem and dl auachmenu were <br />.gl <br />ith a s <br />st <br />d <br />di <br />tl <br />I <br />d <br />d <br />l <br />d <br />d <br />~ TELEPHONE DATE <br />/J/ <br />~ <br />J on or super <br />ance w <br />y <br />en <br />er my <br />rtc <br />on <br />n aaeor <br />em <br />es <br />`ne <br />prepare <br />to assure that quaH6ed personnel P^~~y ether end evaluate the Informalkn I <br />~~ <br />" <br />~ V/~~ <br />, /~ <br />j/ S <br />` snbMtttd. etaed on m~ Inquiry of the person or persoro who mene6e the system, <br />or those persom ditxtly rerpomlbk for therl~ Ibe Informstlon, the Informegon _ <br />~~-~ J <br />C'~'''`~ -- <br />~`} <br />, / <br />~ <br />/ <br />//,~ <br />v1~' ~ ,,.~/ .~•~~~ ,/ `/ ~ <br />~/'~S <br />`° (~ ~ / ` submitted b, to the Dell of m knowkd rand beNef, true, accurate, rand com kte. <br />810NATURE OF PRINCIPAL EXECUTIVE ~ <br />/ ~~ <br />~~D~ <br />%' ~~ <br />/ 1 am await Wtl there are sI~nlOunt penaltla for mbmlltln~ fa6e Inforrmtlon, <br />TYPED OR PRINTED IndudlnE the possibiuty of ene and Imprbonment for knowlne vlolaUo~ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fRIl1/I/!CI e// ithcnm~nts h~rtr) <br />TSS :~< TC'1Tr~'IL IRL~Ii! 1.:t1"i~~"5 Y~~L.i~ T31v t~~,~~~L}, ~~ ~~TT~~s~liil~~ SC)LiI35 L~i'9~T ~1T'~'L.TE~ F'OR !:-3,0°a°R, ~~H~~ ~'i~~~;T~ ~V~I'+4T- <br />~~~ ~iUl~t?.~+~! Cli= ('I?E30~= I~~Qt3ii~l:~i'I;i~l'T"~r Ui+~i~?~I~ ~. ,~. ~. TI;}~ t'~iDI~1TT©I~IEU~~ - I. T3. ~. <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. t~Q ,Tt"Ij Q / ~#~~~4 ~.f4~• PAGE ~ F <br />