Laserfiche WebLink
PERMITTEE NAMf1AODRE55 (iwrYL F~eiYryN~./Lor.rla. (/D(Q~.waJ NATIONAL POLLUTANT OISCHMOE ELIMINATION SY9TEM /I/`IPDES~ <br />NAME ! , ~ DISCHARGE MONITORING REPORT IDMRI <br />ADDRESS _ ;-~i'r' D I •~ _••: i ' <br />STFiY~-. H;~:, PERMIT NUMBER aSCHMOENUMtlEA <br />-'''~~~ MONITORING PERI00 <br />FACILITY ., jWy"~ i`t j ~{~ YEAR MO DAY YEAR MO DAY <br />LOCATION ,•: ;_;=itiFR GO ,f3I'.. FROM TO _ <br />Form gpprov~d. <br />OMB No 2040.0004 <br />.. ~;_., <br />s 5uf„= <br />M - I iii i iR z t-! ~~ <br />. (; i ~' <br />NOTE: `Rssd Imtructiorw bsfors complsrMq this form. <br />RAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FaEOUENCr <br />of SAMPLE <br />PA EX TYPE <br /> ANAirsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> ~ w c <br />• . <br /> PERMIT ~ . : < it o- • , <br />t~t7>'1T <br /> REQUIREMENT .. I <br />MAX ! MI:I <br /> SAMPLE ' <br />o _ I•, MEASUREMENT <br />c <br />-:,'~ PERMIT L .. _ <br />' <br /> REQUIREMENT ~; L' •; :' u U' F~ . L i 1: _ <br />_ SAMPLE _ . <br /> MEASUREMENT <br /> ~., ~ .. ~ .,-._. <br /> PERMIT ~-t.~ , <br />,;<r,, r ; <br />' REQUIREMENT t 1.' . 5 ~~ . Dr? I L. 'y' M... ^:~ . ,' L ; '[:I : i <br />i] - ~ <br />... ~ ~ _ <br />' SAMPLE • <br />• ~ t• MEASUREMENT <br />.... ... -. <br />`' <br /> PERMIT ,. :--F ;~ ;< ~- r- - r <br />~- ~ <br />> l:~A •'.' s <br />" r <br />OA Z LY r~ X ^± ~ ~ ~•'.QNTf <br />. - <br />_ REQUIREMENT ; ._ <br />_ <br /> <br />.: <br />SAMPLE ~.:, :. <br />, <br /> MEASUREMENT <br /> PERMIT ~ .~ ,. ~ <br />l't`~1' MAX <br />r';: •'L 1 <br />t;t:P•I i <br />, ~ ~ REQUIREMENT <br /> SAMPLE <br />-, ~ ~ MEASUREMENT _ <br /> PERMIT r _ n - <br />' <br />~ <br />. <br />: •~•~~ <br />~tQf~Tr <br />- REQUIREMENTC ,. ,~ ~',~.' _ „ ; <br />~ <br />L <br />... <br /> <br /> SAMPLE <br /> MEASUREMENT ~ <br />PERMIT <br />REQUIREMENT <br />_ .!_ <br />~ % TEIEPNONE <br />NAMEliITIE PRINCIPAL EXECUTIVE OfFlCER ' """y " " w""y ° I'" maul. eocvrne"~ .Id .Y .u.cn",fYU ..r. <br />rr.nion 10 K'COrd.nre vlln . 1111frn sallow <br />elrecll <br />e <br />f T <br />r aY <br />e C c~ i E <br />~ <br />p <br />y <br />on o <br />prep•rr <br />Yn <br />l <br />NM <br />J <br />I <br />IM I <br />form <br />ll <br />// <br />~ <br />~ / <br />~ <br />l <br />r <br />~ <br />n <br />. <br />o0 <br />~ <br />/ <br />. <br />~ <br />( 10 laYf! In./ aY.Ml <br />fe pfronfx <br />r .M rf <br />Y. <br />r <br />7 [ <br />P~ <br />// 6 <br />~''• <br />y <br />. <br />.Yel,lru.e. sere °" my IOgYlry °t u» p.n°" or perswn .no ",.".~. Inr fyfvm, n <br />j , <br />_ <br />l ~'r <br />: ~ <br />/ <br />~, :: _ y . ~G, ~ <br />~ <br />°. mof permu mrrruy re.poRdbk ror pln.n"~ mf 11lronruuo0. In. I"ronll.llml C'J ~ <br />' aulMllw Is, r° Ihf Atli of my YnO.rkd~e .ne EeNfr, Iroe, u[vnle. •nd fompkie. <br />~i I ~j <br />-l ~ ' ~~' ` <br />RIN <br />EXE CIfTIVE <br />NA - <br />( <br />~ I..w ...re tMt Intn .re AENnuwt pensitb for .Y4rdulnE hk: lnr°rserUow. 610NA TURF OF / <br />C <br />L E NUMBER <br />C YEAR MO OAY <br />PRUYTED IrY1udl"i IM plldelury or nl.r ."e Impr6onlnenl ror klw.l"~ .lol.tran OfFICfl1 OR AUTHORIZED AOEMT OD <br />TYPED ~ <br />COMMENTS AND EXPLANAIIVn Vr nm ~IV~n..vlw InYrv.fr.-. m. ~.....•...•~.•.~ ••~•~. <br />;FiR Pi2FC:tr•~ E`•/FyT XS C~ Ati`1~J. ?1= t.L_AIt" Ai ~'i~Qir;=-D I.1'r• ~?I~tD: <br />~1 - <br />~ .. - This is a A-par fprrn. PAGE QF <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used <br />