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Form Approved. <br />PERMITTEF}',~'~'I-~q~'-'t'^~'/ADDRESSpndrlrF«W Ner/Loe~Nar_ r) <br />'` <br />~~"`3 <br />s'~JU~4r~~ i <br />t- <br />` <br />L ~;z <br />~ <br />.S. <br />.. <br />._ <br />NAME lJLr4r . <br />.~ <br />. <br />ADDRESS ~ ®1r~t S i.. #11,3. ~ #°~ ~ h1~ <br />P. C~. }3L#r; x'.83 <br />P ACIld I t~ ~ C1 8 g ~~8 <br />FAaLrTY t3Clf=.l I ~ ~~3. 2 ~# I n!~ <br />LOCATIONI~~CFI't# I ~ CO ~ ~. ~c8 <br />~IT~'!~!: 4:JI!_!._.Ii~M ~. ~~~~ J~. , !'~Il~9~ i~~OR <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION of <br /> EX TYPE <br /> ANA<.ys15 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />r- v~ c^i,5~ <br />~ SAMPLE w .:: ~ <br />"~ yr .., . x~ <br />~ " <br />41$ <br />atJF~L. MEASUREMENT -~/ <br />- -- <br />~ 7, . <br />' <br />~©rdti~7 ~ ~ ~ U ~~PERMIT . ~~ ~, ... ~~ .. . ti: ,. ,: . ~ ,. •n #~ . _ i... t 3_. <br />.,. L <br />~F'FLrU~#~'Y' G~~~s 1~r~3...1.t ,EtEQU1Rl:MEN1' ~S'~#s~F~ MA:K ;dU=t3 •~'~'~'•i <br /> SAMPLE <br /> MEASUREMENT <br /> s ;PERMIT <br /> kEQUlREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> >15ERMIT <br /> R.EQUIREMENT;, <br /> SAMPLE <br /> MEASUREMENT <br /> '.HERMIT <br /> RECII{REMENT <br /> SAMPLE <br /> MEASUREMENT <br /> "'PERMIT '': <br /> EIEt~UIREMENt>~ <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT <br /> REOUIREMEN'f'; <br />................. <br /> SAMPLE <br /> MEASUREMENT <br /> .>f+ERMtT <br /> I~E(]UlREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER t tt^'~y u r pens ty o law that thb doarmem artd di attaeltmenls were <br />stem desi <br />.6i <br />I <br />ltA • s <br />ned <br />di <br />ti <br />d <br />d TELEPHONE DATE <br /> on <br />n aarnr <br />arttt w <br />y <br />` <br />rec <br />on or super <br />prepared un <br />er my <br />to assure that quaBOed personnel Pr~Ny bather and evaluate the Information A <br />~ <br /> submitted. Bead on my irpulry of the person or pence who manate the system, ~ <br />/~~ <br />;~„ <br />~_\1 \ i <br /> <br />or those pernorn dlreety reaporolbk for ptherln` the Information, the Information jI <br />~ <br />// <br />[} <br />\ <br />_ /' / <br />j~ <br />~ <br />J r~ <br />J-~G ~ S ~ ~~ submitted h, to the best of my knowkd~e and beNer, true, aeavnle, and mmpkte. <br />URE OF PRtNCIPAI EXECUTIVE <br />N ~, <br />]] VV %a J- S~S~ (} (J G ~ p~~ <br />QG <br />6.- . <br />CJ I am awaR (h\t IhtR aR ai(IIIIIeanl pMaItIO fOr fYbmlllln( faNe Informt1I011, 810 <br />AT <br />PED OR PRINTED Ineludln` the posslblilty of One and Imprhonmrnt for krtowin~ .iolauoln OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY vIVLA I IvNS /Ka~r~nc~ a/i ~rrecnmenra nere~ <br />sETTL..~'~Ir3l_~' soL.IOS R...Ifti1T - ~4~t~L.I~s t~nlL.~ I~" ~.~GV€~, ~~a-~R ~'~r:.c?'P ~vlw~lT ~s t~Le~I~`I~®. If- cL,f~~'~'1 ~l~~Ea©v~~ ~v wt~~~, <br />T8s >y I(~t~l~S L.'~ NlIT s t~lILL. !~!®'T ~'~ i~Pt='L.I~D TC} ~tE#/'®R"~~}~ €'i~~sUR~i~~i~lTs-sL~ E. ~. 3, ~°O ~~-~ ~C3~ ~l~Rt3~f~9 ®~° PI~4]C!~' <br />t?I^'C'~f:~'f'~1='ib ~ r' a. .csc >r_. ~a cs~, o - "' "' ; <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. far(jf) ~y. { ~jTjI1~~ ~ 4-p~,~Pt1-. PAGE ~F <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPOESI ppAB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /DA4R) !`3.(l~lC3 <br />tea: , ,, t sL}I3R i='!r~ y I <br />PERMIT NUMBER DISCHARGE NUMBER ~ '"' ~ ~ l~~L- "/ Ik~L.T~1 '' <br />5>~rP~IN~ €~TR 7CB ~~I:4? TI?~ig~ I?TC#-~ <br />MONITORING PERIOD <br />Y A Y D ~~#~ j1#Cl :~}%sC#-3~AF~U~ #~# ~"u"~' <br />FROM TO '~-- <br />NOTE: Read IneRructlora befolre completlr-p thte form. <br />1 NO. FREOUENCV SAMPLE i <br />