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PERMIT-TEE.NAME/AQQRESS.pwrySi..vltgNw~!forwta~l/D(Qrw.rQ, NATIONAI POIIUTANT aSCHAROE fIIMtNAT10N SYSTEM /NPOESJ <br />NAME ' ' '- " - '' j r DISCHARGE MONITORING REPORT /OMR1 <br />ADDRESS <br />PERMIT NUMBER ascH,woF wIIMeE~ <br />.-~EEKEFi -, , <br />FACILrTV ~~ [)LOWYO M I Nlr-: MONITORING PERIOD <br />~oCwTION r~==N(ER ,, {~ •_ -:I ). YEAR MQ D `rt YEAR MO. D <br />- FROM TO <br />~tLf_~Y ~'. SA!VDr.i; ;. '~+P Gr OG:: <br />Form Approved <br />OMB No 2040-0004 <br />~~~ riL~ UISGNARC <br />NOTE: Rssd Intltrvetior>. b~lw~ eomDt~tktq this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. ~EnoFNCr SAMPLE <br />_ <br />- AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ~''~'ivps TYPE <br />- SAMPLE <br />`_~ I BSc:...':?' <br />- <br />MEASUREMENT <br /> ~ • <br />~ '` - <br />?=fiFLU~I:: ..;! PERMIT <br />REQUIREMENT <br />______ , ~ ;~OUA A'Yta .e3F+il__Y MX i^`_- <br /> SAMPLE -- <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> - <br />SAMPLE "' - - <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> <br />SAMPLE --- <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE --- <br />MEASUREMENT <br />PERMIT <br />---------- REQUIREMENT f <br />SAMPLE ~- - <br />MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />SAMPLE - - -- <br />MEASUREMENT <br />PERMIT <br /> <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' """~ " ' a"•'r o ,. tn.t Intl eocvtetent .ne .u .tl^en,nenU +rrt <br /> <br />PteP.r.a ^neer my elr'clhn a wperNltrn In u <br />ord.n <br />»un TELEPHONE GATE <br /> <br />(r • cc <br />n <br />..,etem edtn.e <br />IAN <br />t . <br />~ -7 <br />r <br />_( <br />~. o tusurt <br />~u^tlned penonnet Proprrl~ plMr ^nd e•tdu^le IM Inr"rttt^Ilon <br />enbmllled <br />bred on m <br />Ir <br />l <br />/ tA . ~ <br />~j <br />: "j ~ j_-1r ~~- <br />/ <br />{ <br /> . <br />ry o <br />y <br />pu <br />t yer»n a persotu .Ao m^n^te IM ^ptem, <br />a Int»r <br />el <br />tl <br />+ <br />e/b - <br />~ <br />// <br />` <br />' , t <br /> <br />" penotee <br />rec <br />T re <br />pet <br />k ror t^tbrrl~ the Informatlow, Ine Inform^tlnn <br />^ubtttllled k <br />1 <br />In <br />b <br />t or m <br />Yn <br />l ' <br />/ - _ <br /> ~ <br />, <br />^ <br />e <br />el <br />nv <br />edte ^ne betlef, true. ^e~tnle. ^nd tompkle. <br />1 ^m ^.^n to^1 mere ^re d <br />nlnunl <br />Nth <br />- <br />b <br />d r ~ _ <br />, r <br /> t <br />Pm <br />^ <br />or wt <br />rnll <br />nt hb. Inlontrtbn, iIONATURE Of PRINCIIAI EXECUTIVE <br />TYPED OR PRINTED InMeelnt Ine podbldt~ w nne ^nd IrnpAfottt"ent roe tno.lnt .IW^tior~ OFFICER OR AUTHOgIZED AOENT CODE NUMBER YEAR MO DAY <br />CO T Q FJCPIJI(VATION OF ANY VIOL ATIONS (R~/ar~nc~ sN •th h f h 1 <br />,ii=~E_r,FK~~ ._ •..-rl-. .II c minx en ~;,~ FftECiF' FV'EiJ'f IS CLAIMED. IF CLAZM APPf2DVEi1 I3'Y i~lt~Ci <br />C :~ _ j ~ -•~~.,r I~~y rv-.-S CEE T ~. ~ -• -r., ;EI '^r'~. - <br />- - - .' L_ ~)(i ~ tic. 1 ~'J r. i-- I <br />-~, <br />EPA Form 3320-1 (Rev 3/99) Previous editions maybe used - - T'H'IS IS q ~-AEI faun. PAGE <br />