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PERMITTEE NAME/ADDRESS (taaYlsF.efhryNw/Lot.trosr tJD(Qirunr) <br />NAME t~C;vt',`I•.~' ~r~CS;,Rz=tC:r a ~...~'('1xT'~F'i <br />ADDRESS)'~,,~;,)(aJT:^ ;ACS. ~ I",~S`dJ= <br />~'~t~i~~~`t CCa ~1~2f~ <br />FACam ~ (7~~i t ~ ' ~-Fil. ~ ~f ~ f~~~ <br />LOCATION ~r~f€~ ~: ~, 4 C3 ~ ~ arc ~ <br />NATIOwDISCHARGEOMONITORINa REPORT fDA~R/POES/ <br />PERMIT NUMBER DISCNMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ()!' !, ~ :I. TO (.,) f' 3 <br />Form Approved. <br />OMB No. 2040.0004 <br />P':• i i'aw31~ <br />1 ~LP~~ I"~F~ <br />.w ~:' T E~t~l }~~:~...~I 4~a <br />~",.b~; O~• ~~.' ! 's31... 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O ('J PlRMIT ..,• : <~. ~. <br />., .. __ ~ . -, . ~ ?.f ,... <br />"'~:~: +I t <br />O <br />a <br />~~ <br />~ ~ <br />~~~6 <br />~ <br />~ REQUIREMENT <br />~ ,s•!$3?'ti,° ~~}, . 7 f' t 1 i ' ` <br />~ , tiw ~ u r r~ ?' <br />•~ 3'~~f ~_ <br />dtt.l~.t•..3 <br />tY <br />t._ <br />I <br />.: <br />..~ <br />PRINCIPAL EXECUTNE OFFICER ' «nny a er pen. ty o ~... mat tbb daeumene.nd dl Ntuchmenu Overt TELEPHON E DATE <br />NAME/TITLE prtpanM under my dirtcllon or superrhlon In aKeordann with .system dest`ned <br /> to assort th.t qu.Rtled personnel propery pther.nd erNu.te the Infonrutlon <br /> submitted. Based on my Inquiry of the person or perwro who mnnaee the system, ~ % <br /> or those penom dlrecty nnporolbk for ptherlnt the Information, the Informstlon j <br />/ <br />b <br />I ifG CQl ~ C -! wbmllted is. to the txst of my knowkd~e and beeef, Irve, accvnte, and complete. <br />1 <br />lRnnl <br />Ih <br />1 Ih <br />ltl <br />f <br />l <br />I <br />1 <br />b <br />N <br />hb <br />f <br />810NATURE OF PRINCIPAL EXECUTIVE ~'~ %` . t~,--•~ ~ / <br />. ert art s <br />~n <br />am await <br />pena <br />ea <br />or m <br />a <br />m <br />l <br />n~ <br />e <br />n <br />ornutlon, <br />JhYPED OR PRINTED <br />r Inclnaln` she possibility of Rne and Imprisonment for knowing rlolatlorn. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO pAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IR~l~r~nctr sN ~tt~chrrl~nts htrr~/ <br />S~~'•~"l...Yccl':%3#...~. ~iC.;L.x~~ S_~'~i~ i !-1'r'~'!_.~:f~5 £~C~±LSr ~:: '~~=~~'tPR: ~~•~S~ C'~.~`!•f' iir~+F=l:,i~' Y;~ irC..F~tr'~`•::~T. Y': t„),_,!;~'y^ f~~'~:'~~~~~i'g~~' ~3`t' <br /> 4~~f ~t <br />~"~~ a{ lC~~~ i...TF1~~~ IFSz?_~ P4~'J~ C•i~ ~5~~~l:r=~) ?"~ t~~~?~`;F[3;~~.a !viti ~:~1:+l~~-..;~:.'~+i i• ~ ~;'.~ ~..:=~~. ~, ?~~:' ~;•-•r~ ;=.r~=~ ~±3'r?y?}=!~ C:'T• ;'~t;?~~" <br />,1 _. ' ~.r .=r1~'. a : ,:.t. ~ :v'w L. ~.7 r.".. ~.. .:+ .~ , x:: .i ~a t~s.w ~ .^+=t. .....:~.to <t ,.. t t ., : a, a :. PAGE <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. r ti ~ 1`h> ,IS a, 4: par form. ~OF <br />.: ~ r. r. .3.. E...., i... ._ L_ ~ . E.7 0..: t <br />