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Form Approved <br />p£AMIiTEE NAM£IAOIJNcSS!%+-..farWrrh~+s':-a•~'~V%'~'^' NATiONAl c•~IIJTANT D~SCHA.40E EIIM~NA'.~Gh S'r5'EM ('•l~i~:•~ OMB N0. 2040-0004 <br />DISCHARGE MONITORING REPORT (OMRI . _ <br />NAME ,:[jl U1n;Yl.1 r i•. ~ .- <br />A~~RESS :"; C7LCsLJY'" •, ~ i•+C <br />77.3 1 ~ T ., i . PERMIT NUMBER pI5CNM8E Nl/MSER ~! -' F NTEi~ I M i~ JOO .~r'~2 F Nv L ~ <br />'~•i 16 r'DNI? i O <br />'IE~K FR MONITORING PERIOD <br />FACILITY ::~nLDWYG Kl? ~•~ YE MO D Y YEAR MO D Y ,- _ _ - : ~. <br />TO i this form. <br />LOS-ATE "?LEI~E~' FROM NOTE: Read ir>•trucNw» b~/ws compl~tfnp <br />.. .. .,- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. <br />EX <br />r`+EOOFNCr <br />AriKVSls <br />SAMPLE <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> < -- ~ -, <br />r; <br />(~fdi; '~.r,.:~~ SAMPLE •~.. , <br />_ NT <br />REM <br />,x1.111 MEASU <br />E <br />= <br />_ „ - , <br />' 40E~~ , I <br />~L~ ,,1~T' v~lf~_;. .'~ .. PERMIT <br />REQUIREMENT ~ "' -- ~ <br />_.:ST I"~ :X - 1 <br />t <br />-~ .... • :~~ st , . <br />------- <br /> S AMPLE <br /> MEASUREMENT <br /> _ <br /> PERMIT <br /> REQUIREMENT w•r -- -- <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT _ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT -- <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT _ _ <br />E PRINCIPAL EXECUTIVE OFFlCER ' et"") " " pe"") ° b. th^t Nh AorvmeM .nd .u .u^rntaenU .... j ~ TELEPHONE <br />NAME/TITL prrp^red eider tn) dir~crfovt a nrper~ort In ^ctord^nce wtth ^ s)•tetn dc4tned ~j /~ / <br />' r to eaun IFN qu•Mfkd ptrwnnel progerl) ~s1Aer •nd erdoele 1M Infrn•m•IIW~ ,/]1 ~ /~ /L//mil <br />.: ~• sn~Irltt lld. 6wd on rn) Irpulry of lIN persat or persoru .Ao rnan•~e 1111 ^yelrrtt. `.y~ f ~/J J~~Y~ -. <br />. r er thole prrxme dlrtctle resperdbk fa ratAerint IAe Infonrutlcwt, tlK Infonrullna '^CC// _ f ,~ • . F (i' ° _ 5._ <br />to tAe Dtll nr m) -new{ed~e •nd EeMer, true. Kcvnte..nd rorttpkle. <br />ilted b <br />~ <br />o Drr <br />~ DATE <br /> <br /> <br />, <br />~ ._- , <br />'~ ~I ~ ~s1 / ~ ; U <br />~ ~ ~ ~ r <br />TYPED oR PRINTED , <br />t <br />t <br />t \T .~1.R Uet tncre .re d~dM1caet pendnn ror wemltnn~ r.br infornutMn. <br />Incivdlnt tAe po^~blllt) of etre ^nd ImpAsontnent for kno~in~ .td^Uaei <br />. SIGNATURE Of /RINp-Al EXECUTIVE <br />OffICER OR AUTHORIZED AOEKT <br />COOS NUM9ER <br />YEAR <br />MO <br />DAY <br />^~~MMENTS AND EXPLANATION Oh ANY vw~/t t tuna rnortermc...r ~,~...•~•••-••... ••-•-• <br />H PREC Ef' E~r'~N i F5 CL:~IMFD -~-' <br />_ - ~ . _. • <br />- PAGE <br />_ ~ This is a-4-pact farm. <br />~a Form 3320-1 (Rev. 3199) Previous editions may be used <br />