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PERMITTEE NAME/ADDRESSp,.dVl.F.erNryN.../teruron~/v~Qirer) <br />NAME ~(~I~SII= t~~.~G)U~'i~~~ t_.II"lI•~')vD <br />ADDRESS LiLii.••! I ~ ~~. ~ ~ I1~4E: <br />F'. C. I'C37.' ~1J3 <br />F~~,Ci~3It~', C~ ~3~•~~ <br />FACILITY e~ QiF} ~ ~ fi•~Q .. ~ ("} ~. ~`vt~ <br />LoCAT10N~f-'6f~f'3I(-~ ~:~r.1 Y'~i~r~°v <br />~TTCd: ~.~#_L. t'h€'9 ~. d3~`~~3 ~'r',..• i'~IIi~IE i`~OR <br />Form Approved. <br />NATIONAL pOILLtTANT OISCHAROE EUMtNATION SYSTEM //NPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /DMRI ~ I ~[j~ <br />O ~~I• r•7~, QL.1~i X C ~al~1~R MN i <br />PERMIT NUMBER DISCHARGE NUMBER ~ ~•' I €E4~L.. O~~•-T~ <br />MONITORING PERIOD ~ ~~~€,! T ~ Ini~7 T€5T' ~ €~!~ ~~'r± Ora~~ <br />Y MO D Y D Y <br />FROM r TO •~•#3.i• €'d~ C+:~wC~rRrR~v-'~ ~ ~# •d•#~• <br />NOTE: Reid Instrucdor» beitx~ completing thle itxm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION n10, <br /> <br />EX pREOUENCY <br />of SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />i ~ Y, SAMPLE a•xE•3d~•~-#•Y •#•~r:%~•if#•~• •"tt••3~##~1•~• #::••~•#•li•~k d ~CS's <br />~Ii"1~~1-•i~a~.~5 Ct-I~iCI{VIC MEASUREMENT <br />i~1~c~~ ~ ~d ~ >PERMIT ~#~~## ~?:•€#~'~ ~ ~# #~#~#„~- :3•sk?-t -3x'i~ ~i'~4~~~1C ' s: C'.~. :_.f?~'^.... <br />S~~ C(~~sdi"1~i~(•4"~ %3Et~©~! REOUIREMENT x~# u~fidt~~r~Mf* TQ~{:~" <br /> SAMPLE ~ <br />/ b C <br />" %' ~ ~~' <br />(~ <br />F <br /> MEASUREMENT - <br />, ~ <br /> PERMIT <br /> REQUIREMENT, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ~tEQUIREMENT, <br />................................ <br />.......... ................... <br />........................... <br />_.. _ __ <br /> SAMPLE <br /> MEASUREMENT <br /> :PERMIT <br /> RE<lUIREMENY <br /> <br />...:::...... <br />:.. <br /> SAMPLE <br /> MEASUREMENT <br /> 'iPERMIT ``i <br /> A~f1UIREMENT <br />::. <br /> SAMPLE <br /> MEASUREMENT <br /> • `PERMIT ;' <br /> AEC1UIiiEMEN~"` <br /> SAMPLE <br /> MEASUREMENT <br /> C1~ERMIT <br /> RICIUIREMENT;; <br />TITLE PRINCIPAL EXECUTIVE OFFlCER ' [[^'ly ° er gem ty o isw thN, thh doavment snd su sttschmenN were TELEPHON E DATE <br />NAME/ prepared under my directbn or superr6lon In oe[ordana with . system desl`ned <br /> to usrre thot queMOed personnel P~riy [other and erduete the Inforrrallon <br />sobMtted. 6rned on my Inquiry of the person or persoro who nuns`e Ilre system, /~ <br />J//~+y~Iy ~, <br />/ <br /> <br />/ <br />~,G ~/ ~• ~l~j U ~ ~ <br />C '~ <br />or three persom dlrecNy rrsporolbk for ptherin` the Inforrrution, the Informsnon <br />submitted b, to the bnt of my knowkd~e erd beNef, true, ocenrsle,.nd complete. <br />nlRnnt <br />Ihst th[re ere s1 <br />enNdo for <br />ubmllN <br />h6 <br />I <br />I <br />f <br />tb ] <br />` <br />~/t/ ' ~ ~ <br />EIONATIIRE OF PRINCIPAL EXECUTIVE <br />l <br />9~G a I• )~j ~ <br />j~~ <br />~,.!(~ <br /> <br />O ( <br /> <br />!~[ <br /> ~ <br />sm aware <br />p <br />n~ <br />e <br />n <br />orrm <br />s <br />n, <br />TYPED OR PRINTED Ineludin` the posslDllity ovens and Imprisonment for knowln` rlolstlom. OfflCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS /Ref~r~nce sn erncnmenra nerd <br />5~'.~ F'(3F?'a 3. F`v. ca E'C?~t ~~'Tf-~Ill._c~•' ~F' T~t~'T PE~C)~~~1~Ui:?!=. F~'PT F2!_SU~"f~ q~' i_.~'i'I~PsL.ITY E3~RT~15 1`~~ °,~'1=~'~CT", G~~CII~~i'h-i ~yfi`Il~ <br />~~'t~i~C3i3 I3~~';~i'~ ~§5 "l('l~~3~?'TY". ~~•'~~' }....t.~l;~,~:,~"3T % ~~~'~ 61T I+JI-•lI(:1-~ ~"T'~1TZ sTI~'~tL.l...Y SI~£~.tlt-" I}I~~ I3Ttd1I'3 '~'~T ~c ~C]IUT~d©L <br />.. . ~ ~._ .y .. G . .~ ~ 1 .... r. sm. .. , <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. ~ ~;~ ~~~ ~ ~ ~ ~ S ~ 4-~~1' ~ ~ri11. PAGE ~OF <br />~,, 1.1 <br />