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PERMITTEE NAME/ADDRESS pwdrJrF.nbryN../toe.nnn (/D(QGrsnr) <br />NAME~.CIs9flF.= Ia~51=1Ur~3C~~ LI;"IT~'e:.l~ <br />ADDRESS ~ ~~'") ~ ~ ~d • ~ ~` ~ ~~ <br />I?. fl. LtlX -ii33 <br />FAalm OI;I~) T ~ I+lq. G i`'I T IW~ <br />LocATIONP~df~1 L c~ C Q ~ i X21:3 <br />~TT•f;!' 4al'~L:3'f~t~i !a k3F"A~ ..)I~_ MYf~I~ 1"iGF~ <br />_ Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDES! OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT IDMRI P'I ~ (yl(~; r <br />CQ~}Q~kE?~'Tu UQfl PI (St1BE~ i~Tl-i } <br />PERMIT NUMBER ascHAROE NuMaER ~' -• I''• I fyr'',I_. I~~i..•~"~ <br />pflCvl-~ fl~ aft Y"i~ i~s.lfi+ll•d Tu(-li'd ~ T VEF~ <br />MONITORING PERIOD <br />Y AR MO DA Y MO D Y <br />FROM ~.c. TO ~ _ ~••'s3•:: I''•i~ ~}:~CI'-If3ai~0~ I ~ I •'si•~••si• <br />NOTE: R~~d Inetfuctiom betw~ complytiny thie lofm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, pREDUENCr <br />OF SAMPLE <br /> EX TYPE <br /> ANALrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />I._ E~1 ._.. S SAMPLE •~•;°-••~•:F•3)•'ri• ( ~Yp• } •'ti•~.r-~'>.k•#•31• 3~•.~••3.'••:'S•3i••i4 n•#•?:•~3t••?E• <br />~} ~ St•1~L MEASUREMENT <br />fl~•Q+~~ 1 ~7 Q >PEfIMIT ?i3F-~•#•~•# Ei~.i C3RT `Y ~:~.==1. ~•~-#•sE•#-~ •r•:r~u•is•~#~z •si•#•#~:s:~: ?-~•#b•~ ~~_~.i._''C :'a:;,`-!c'~ <br />~~`;= I...s~',:I~i-~' ~~~~s ~~;~~.~ ~~auraEMENx z ra ~`~ rl~,:~ ~~~~~ •~~•~•=L <br /> SAMPLE ~ <br />~ <br />~ <br />'' <br />~ <br />~ <br /> MEASUREMENT ~ <br />(~ ~ % <br />,, <br />~, ~ <br /> ..PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ;,:PERMIT <br /> REIIUIREMEN7: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '> <br /> REnUIREMENT' ' <br /> SAMPLE <br /> MEASUREMENT <br /> .:'PERMIT <br /> R~nuREMEI~it' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT' <br /> REQUI!#EMENY` <br />_ _ .._ <br /> SAMPLE <br /> MEASUREMENT <br /> ';f!ERMtT I <br /> REIIUIREMENT» <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t army o er pena q o Isw thal mlr daeumenl and au attachmenb were <br />stem desl <br />errMon In aceordann with ~ s <br />ned <br />direction or su <br />d <br />s <br />d TELEPHON E DATE <br /> e <br />p <br />y <br />un <br />er my <br />prep <br />re <br />to assure lhal quaHlled personnel Proper(16alher and erduale the Informallon <br />wbmltted. laud on my inquiry of the person a persoro who mana`e the system, <br />~ <br />.~ ~ <br />J~~i~. „ <br />~J / <br />/ `1~G~~ ~ L!G•~~v~ <br />/ / or !hose perwro directly re+porWbk for ptherlrrH the Informallon, the Informellon <br />submitted Is, to the bell, of my knowledHe and belief, We, ae~vrste, and eompkle. <br />~ / <br />_ <br />~/ <br />SIONATLRE OF PRINCIPAL EXECUTIVE /'~~ n _^ ~ l~~ <br />`` %J"/'..3" ~ Q / a _ <br />Cf. <br />,/ hbe Information, <br />1 am aware that !here are sl(nlnGet penaltln for mbmllHn~ <br />• PED OR PRINTED <br />Ineludin` the posslDllity of nne and Imprfsonmenl for knowln~ rlolallom. <br />OFFICER OR AUTHORIZED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />OAY <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS /Re/Mince mi efacnmenrs nerei <br />SST"4•# ~~~~...~ ~is'i' Tea ~.TI'~dT•1" A4"~r Tina fl~}_~ TF' <:1(J'Y12, ~?4MF? PE~I~CTt~ ~'J~s'it'! T5 C~..~Ti"9~~. s~ Ck..~1T~"i ~ss^F'J~'l~~~O :(i's' In1C~lCT}f <br />T~~ ~a T~flY'~? LTf~#TT5 t3I1...1_ l~IC3T B~ ~1~C-'1...:~~=0 TC3 ~31"f'flf~T~T? 1'')~~I~UR?~f"1~NT5-~~E T. a~. ~, ~'P E;-~ `ti~1~f~ ~$I,.li~T1~1~3 E71^' I:'I~C'C1Ct~ <br />„ ., , <br />-. ,...t., ., ., ... ,... ~ ~ _ 4- rm. PAGE OF <br />EPA Form 3320-1 (Rev.•3/99) Previous editions maybe used. S3C`3'~~~~• j ,F'i~T~~- Q~~~ c! <br />