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f'ERMTTTEE NAME/ADDRESS(hsrblrF~elNryN~w/Loearlonl/D(Qirenr) <br />NAME lLi~~~~c F~~~C31/FtC~t`'s " ,...1 <br />ADDRESS~~iIJ~T~ ~~IQ. ~ It3~(~ <br />~'AS71~ ~ <br />FACILITY ~ ~€4~ ~ ~ I~11. ~ I'~ ¢ ~ <br />LocATX>N~ c~C.IN ~: ~ <br />+~, r "I•hI - I,~{ 7 I 1 ?' ~N3 ~ Y-i i~fi~F? <br />u 3 I"I d ~ i~.l.. <br />{ ~ t.'•~`'~3• <br />L' <br />C~t"1. ~# ~ ~2H <br />14"~ "s~ i' I~t~= id2Q~~ <br />NATIONAL POLLUTANT DISCNAROE ELIMINATION SYSTEM //NIPOf$1 <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM {} ~' ~ ;~} .• TO (,) ;/ ~, ~? ~ 1 <br />Form Approved. <br />OMB No. 2040-0004 <br />1'1 ~' f31±:a <br />d fi.--'U<3F'. i~~S-~ 7 <br />~~; ~a~~:=~f ~~1.. ~ i ~ ?~~ lf9lt~~J s ~ ~ ~3 <br />NOTE: R~~d IMtrucdons b~ftx~ complytiny this fofrn: <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX pREOVENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANAtYSts <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />~;I`~1») G~~~~~ <br />- ~ L SAMPLE ~:.~..~..;~..~•~.:r. ~ t~~! ~ ~: •: :;•~:1• ~.~;. K.•?•#=.*• ~ ~;• k~•:'.••r'.--1'. = •w. <br />. MEASUREMENT <br />~ ~ 5191{ <br />4.O~af~ ~ O ~ PERMIT >z-_. ~ .i .: . i~ ~ft ! ^~" ~ '~ .... .. .. ?~ . ,. ~id~• a it_.:H°,f~Y ~ ~, .~ _. . <br /> <br />_ <br />~'~• ' .i:` -_ '~" ^ .L'~~'. it i ! ~~. R~f1L{IREMENT P i Fr ~ ~'(~~(~ ~ ~.~;. <br />~• n -t <br /> SAMPLE <br />MEASUREMENT ) <br />~'~~ <br />~ ~ <br /> / <br />r l T , <br />/, l'. /;~1 <br /> :PERMIT - _ %i <br /> .REQUIREMENT <br />_.._. <br /> SAMPLE <br /> MEASUREMENT <br /> `.'.PERMIT ;, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ''.PERMIT '; <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ;'.'PERMIT ' '' <br /> RL~f1U1REMEN'f <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REnUIREMEN'C <br /> SAMPLE <br /> MEASUREMENT <br /> `'PERMIT.' <br /> REQUIREMENT <br />NCIPAL EXECUTfVE OFFICER l n^"y u er pent, t~ o eN thu mb doeumenl trod au Nt~ehrnenu were TELEPHON E DATE <br />NAME/TITIE PRI prepared under m~ dlnxtlon or superrislon In aeeordenn wllh • sptem dd`ned <br /> to more Ihel quatlfled personnel proped~ plher sod erdude the Informallon <br /> submitted. based on my Inquiry of lire person or persom who manate the system, / ~ ~ <br /> or lhtrse person directly resportdbk for plherln` the Informagon, the Informetlon /~' <br />/ <br />~ <br />/~ p 1~P submllled h, to the best of ml knowktd~e and betlef, true, sxivrale, and complete. <br />nlflunt <br />re the! then ere sl <br />w <br />enaltles for wbmlltln <br />fabe Inf <br />1 <br />m <br />rm <br />ti <br />sIONATURE OF IMIINCIPAL EXECUTIVE ~~~ ~ (~ !~- ~ - -) ~ ~ l ~ ~~ <br />_ , <br />. ~ <br />a <br />e <br />e <br />p <br />3 <br />o <br />a <br />on, <br />(/TYPED OR PRINTED Includins the poslblllly of tlne and Imprisonment for knowln~ ridatkms. OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rd~rence sN ettechmente here! <br />~T'~"Ir~:fi~L <br />~: '~~~~~n75 L.~"~~*;:~~," At~~~'L.?~~ I"!il,..'tr F~ _=:~t`=Y1•',t'z'.~3i-E~ I~?-til:~C:a:~' ...~,;~...jli" ~:~ C'~:'r6':,:~. '::~' u"_s?~'i'1 gi'r't=~i~~~~~~~ `~`~' ~JC~:1~~~'. <br />. <br />. <br />-{-~~w' ~.:{ ~~,~sl~l ~....Q!~f~ 3."Y~. 'lil{$i..l.,. 1~~1.7~ ~t'. ~~?+~~t...d~-xo ~~ ~~s:.i'~r~ {:'~ ~~_~~~5.1i'~i~i`'~~~~ti"~~_j:_ ... f:. :>t ~i.~t` u.. _.`...t." =~..{~ ~a.)~"i~''~~~ <br /> ~'' ~I'~~w~?` <br />f"'A.'we, 2 ti, . r c.~ 3~~ ~•~t"y a:. - --$. y.. ~. _t <br />t;: i._,A! s, <br />us editions ma <br />be used <br />' <br />EPA Form 3320 <br />P <br />i <br />3/99 <br />1 <br />R - ':. :.:t:: S :~~ :' ~i°:C°ti"'t_.?. 1'.:s ~ty.,'^ I ti~E.ei.: <br />~ _ l ::i'~ ... , y~} <br />PAGE OF <br />4 rr181'I fOfitt. <br />~ IS~S <br />IS 8 <br />, <br />, <br />.~ <br />- <br />( <br />ev. rev <br />o <br />) . <br />y ~I <br />ti <br />, <br />~ <br />t ? <br />