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PERMITTEE NAME/AODRESSpwrl~4r Fw•wrylv.,,.,y«p1,,,VD~~~ N <br /> <br />NAME <br />~ ATIONK POIWTANTDISCNMOE ELIMINATION SYSTEM rN~CE.sI <br />DISCHARGE MONITORING R <br />P <br />~ : ~ ~~~ <br />ADDRESS <br />r, <br />- .. E <br />ORT (OMR) <br />:,~ ~ OME No :040.0004 <br /> <br /> :~.ER PERMIT NUMBER ascNAwoE NUMeE11 i -' ~•; , ,i_ . <br /> "~ <br />r _• <br />?T " <br />F' Il" 5EL` ''t)~ <br />' <br />c <br /> <br />FACIIRY f,fYO MTI~ <br />~ <br />E' <br />MONITORING PERIOD . : ~ <br />~; ~. <br />~, <br />':J TCI ~ <br />LOCATION YE R MO DAY YEAR M - DAa' <br /> FROM TO <br /> <br /> NOTE: Raad itwtructlort» b~1wa compbtMy thi>, form <br /> <br />PARAMETER <br />QUANTITY OR LOADING . <br /> QUALITY OR CONCENTRATION NO. EREOUENCY SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM EX OF <br />AVERAGE MAXIMUM UNITS ANAtrsls TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />-FFi_,(,I ~NT ;. .. •~`~• ~. RKAl11RFnACUT . _ __ , _. ., <br /> <br />REQUIREMENT <br />G~~ r~~ <br />Nn aI°~ <br />~~ <br />61oNATVRE Of I <br />OFFICER OR A <br />' :.ES ONLY IF <.'_ rit, c4NR PRECIP ~VE•I~IT ':$ CL <br />TS?; (' I ,~ r I 7 -p _ T _ , _ ,,.. t-1 • . "f ._, - aEE I <br />.. <br />EPA Form 3320-1 (Rev 3199) prevrous editions may be used <br />InC7-AL EXECUTIVE - <br />iHORIZED AGENT CODE NUMEiER <br />!., ~ ., L <br />G0~2 ~' .• _Thi3 is ~ a-patt'form ., <br /> <br />