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P£RMITTEE NAMEMDDRESS(1naLlrFoelNryNw/Laeale.rl/D(QGrenr) <br />NAME ~'P(~pp~¢2 P'II~9Ii~4~, Ti~fC. <br />ADDRESS W FtA~'P~R ~ilRf~ <br />P. D. SOX I~7 <br />C$2~I~ GU ~"3cs2t., <br />FACILITY '{"~~~ ~ ~~ j~') j (~~ <br />LOCATION 1 ~j ~ ~ ('',r C ~.1 $ '6 b"~.. rj <br />t~`~'~"S~I: ~tP~aYl"IDI'~€I} Cy. I7U T3J?'~, Y~Ft~S!(3t"i <br />NATIONDISCHARGE~MONITORINa REPORT /OMRPDESI <br />C DC}C~321 ~. 5 00~ ~ <br />PERMIT NUMBER DISCHMOE Nl1M9ER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM .~ TO ~ <br />• Form Approved. <br />OMB No. 2040-0004 <br />~i I P~lD <br />( sU~Fi UC } <br />PDf~iL} ~5 TQ SAID i~i1~~`3~ Gf1LC~i <br />NOTE: R~~d imtructiom b~1tx~ cornpNtiny thb form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />X FREOUENCV <br />OF SAMPLE <br /> E N+Alv~s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />®~~ t`al'~Ig} ~~~61SE SAMPLE <br />MEASUREMENT #3P',t~i'r~t# ( ~j1,~.} :rs`E~~a ## rl•#•~#>## ~a••i$ix#~•:F <br />~ <br />~ <br />~ ~ SUP~L ~G <br />X34066 1 0 C! <PERMIT #n-~-si #it R~FORT' I~~= ~. #st~#3EtF-x• ~#sF~t•#•~ •~~~r#:~•# ~•#:E~# '.P,iG~.~~` J:~.~,{+~=, <br />~fr'~'I,..U~h9T' GP(3~~a Vf~LU REdllliiEMENT` Ih~l~T P1t~~ Rft7.=0 '~'##=fi Mf7i~t ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> "'' ;,PERMIT <br /> •;EQUIREMENT <br />........... . <br /> SAMPLE <br /> MEASUREMENT <br /> ''.PERMIT <br /> EtEQUIREMENS'. <br />.......................... <br /> SAMPLE <br /> MEASUREMENT <br /> _' PERMIT <br /> REtlUIREMENT' <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> R~<2ll I t:E llillN <br /> SAMPLE <br /> MEASUREMENT <br /> __ <br /><' PERMIT <br /> aEQU~aEMErrr>~` <br />............. ... <br /> SAMPLE <br /> MEASUREMENT <br /> ;PERMIT r <br /> R~C]UIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER r ceruty. er pena ty o law that thla documrm and di attarhmenb were <br />prepnrcd under my dlrectbn or aoperegion In nttrordantt wltA a.ptem desl`ned TELEPHONE DATE <br /> <br />~0~ ~ ~ ~ S <br />a to more thN qu.HOed perwnnel P~~7 6nther.nd eenluete IAe Inforrrullon <br />bm <br />e <br />d <br />i <br />i <br />a <br />~ w <br />tte <br />.ee <br />on my <br />nqu <br />. <br />ry or uk person or persorn who m.n.ee the system, <br />/ /~ ,/' or thox persoro directly respordbk for prtherlrK the Information, the Informepon ~ <br />~~, /„~// ~ /~ <br />~~ , a~ / / .afJ, d'~ ~ <br />CCC~~~ l:~ ~ / r wDmltted Is, b the hnl of my knowkdEe.nd belief, lrve,.cavnle,.nd complete. <br />~ .m .were lhnl there .re sl~ninunt pen.ltles ror wbmlltln <br />nbe bronmtlon <br />EIONATVRE OF PRINCIPAL EXECUTIVE ~® a~ <br />J f ~ <br /> { <br />, <br />TYPED OR PRINTED tncludin` the poniDllity of arse and Imprisonment for knowlnE.Idalbtn OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXFLANA I wn yr ran ~ vw~p-1 wns I/f~r~r~nctr sn ~fr~cnmtrnrs n~rlr) <br />`I'~~ $< Tt7TAL I f~DSei ~ I NI ~ T'S ~i l la.y D~ W:4 g 11~I}, ~c S~"I'l'L.~t~I3L~ ~~",DL:~ 0~ ~. k ~ 13 ~,PPI....I I:I} FDR ~'~ 1 OY~, 2~W~ PR~C i P ~t6~h9T- <br />5~~ I~URD~i~! C3F' i'RDD~ i~~Q4J~i~I=6"IctVT'S Ui~3T7ER I. 6.1.2 ~0~ C~l®hiI'i"DR1it1~C - I. Z3. °?, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. ~~~}~®f O'~[ite~~~i¢pa(ic~fiDrm, PAGE ~F <br />