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PERMTTTEE NAME/ADDRESSpweY/rF~rWgN~w/Leearonl/DIpGr~any <br />NAME •TR1`"~l~P~~ !y!I!~l3t~G, IhlG. <br />ADDRESS ~~~~~~~+ id~giU~ <br />P. C). Y3DK 1t~7 <br />GR14IG GC! ~?.b~~ <br />FACILITY ~ ~~~F2~F2 !'Pl~i1l~ <br />LocAT~loNGi~~,iG GC! ~}.6~5 <br />~, i 7!~!: ~.AIY~'!®tdl7 G. DU IiQIS, !'R~~jGM <br />Form Approved. <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM //NPDES/ OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR/ (~ I I~iOFt <br />GQ003c ~ 15 fJO~a ~ t ~UBR .,.tom <br />PERMIT NUMBER DISCHMOE NUMBER )= - 1= I ~~~~, !'~QF~A'3• <br />MONITORING PERIOD ~ X 51rl-~`yR~~ ~~ ~~ '~~~~ ~l`L.Gl~! <br />YEAR MO DAY YEAR MO DAY <br />FROM r Tp t=. #a~# it!'~1 ~ISG~l~E~r~ !~! •~## <br />NOTE: Reed Imtructlorti before completing this form, <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> of <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(,7I1.. ~fl~I7 ~s~rEfa,~E SAMPLE 3F•3'r:~•#a"rif 4 '~~) ?'••iE•'w-:e• 'ci-S'~•ti8# •#iz#3f#•tF <br />~" j SU~~ MEASUREMENT <br />I~~l7~ib ~ (~ Q PERMIT ###### f~'j•~~ ~,,,- ~•Y#### ###•### ###### r~t#•#•i• t!~lC:~,r I~IwI$' <br />~F•i= i_..U~i'~!i' f3l2 C2"a~ ~ALU gl:dUIREMENI' <br />_. l~S7 MAX i°!t]=U #•~# r~ h1i~!`•l ~~ <br /> SAMPLE <br /> MEASUREMENT <br />I• <br /> <;;PERMIT <br /> REQItIREMENt <br />.................... <br /> SAMPLE <br /> MEASUREMENT ~` <br />1 <br /> s <br /> Pf:RM1T <br /> REQUIREMENT <br />~~ • <br />~ • ~ <br />Y SAMPLE } ~ <br /> MEASUREMENT } <br />• <br />' iPERMIt <br /> REt1l11REMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ::>;PERMI:T sa>>! <br /> ~EGUiaEMl;N~F` <br />• ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> <br /> <br />. REQUIFiEMENY` <br />............................ <br />................................ <br />.............................. <br />.............................. <br /> SAMPLE <br /> MEASUREMENT <br /> ,<f!ERMIT '' <br /> <br />. ~iEaUIREMENt <br />............................. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' «n~ir u er peon t~ o law that thla document trod NI altachmenb Overt <br />TELEPHONE <br />D <br /> <br />prtpartd under m~ direcllon or wperHaton In accordance with • afslem deaiLned ATE <br />-/ i <br />~ ~ to asure that quaNBed personnel Pr~rl7 Lather and eraluale the Informallon <br />~ ~ /s <br />U 1 f%'~G~V snbmlttM. Baxd on mr Inquiry of the person or penoro who manaLe the arstem, <br />/ or thane penoro dlreetlf respomibk for plherlttL the Infotmallon, the Infornullon /~ /y <br /> <br /> <br />' r ~ ' <br />~S <br />submllted b, to the best of m~ knowkdLe and belief, true, accunle, and complete <br />~~ <br />7 <br />~~~J~/ <br />~ <br />} <br />~ <br /> <br />~ ~A/1 C <br />1 am await that there art slLnlBnnt penaltle for wbmlttlnL fabe Intormatlon <br />EIONATURE OF PRINCIPAL EXECUTIVE V <br />UyTEp , <br />Indualn <br />the <br />aiDlllt <br />r One and I <br />l <br />f <br />TYPED ~ pR L <br />po <br />r o <br />mpr <br />aonment <br />onknowlnL rlolaltoln. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />GUMMtIV 1 S AMU [JU-t~rtn t rv~~ yr n... ..v..n ~ was tnw,wrmcw mi wuwci,mwnra nwrq <br />TSB °~z T€71't~L Ti~G~! l...Ii~7IT•~ WILL B~ W~Tt~~D, ~ea•i~Tl'1...~~",I3i_.1.=. ~G't~Zi:?S 1...~:i'~~'~ ~?IP~°l..I~B T=iilf•%v •i=FdYF~, ~41t•11~ fi'?~EGIP ~V~i~ll'-- <br />S~~ ~3URl~~i~l. UC' PRG®i- ~tEQUTI;iwR`l~~fl`S 4./!+!I?i"Fi T, a~,. ~. TOS M'D!tilTi'C!r`aI€e!(p - I. !3. ~ . <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. Q~3 ,4, y O j (~X~ta}~¢~~f{~np, PAGE ~F /~ <br />