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PERMITTEE NAMElADDRESS tbrcludr Fnrilur r1'nmr/Lualian iJfhffrrrnr) <br />NAME <br />ADDRESS <br />FACILfTY <br />LOCATION .. ~~ Cl7 iJ 1 b3S <br />~.~,~~, r:?tcl_ar~aTiorl r~ar~dAsER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2~ 0-0004 ~ <br />MItd~P <br />~SU~ <br />n~;'t'r: Tt) ~~-n TT3 ~HUt;rt=P~'rtly t;ULCH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMU <br />M UNITS <br /> ~ 1 <br />U (l <br />~ I~ , I I ~~~ <br /> MEASUREMENT (1 <br />' l <br />lJ - v <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER l arrtir. °nd`'r Ix•n,dt. of lax that thi. drxument and all ultachmrnt. xrrr TELEPHONE DATE <br /> prepat rd under mr dirartitm ..r ,ulx•n i.inn in wcurdance xith a +~arm dnigrted , <br /> t~. a.aurr Thal ytulificd prtWmnel prnprrh Kathrr and nuluate the infurnretlon <br /> .ubmittad. fSa.ed un ms inyuin u(Ihr pcnon nr lxr.,me xhu nwmyro the sJarm. -_ <br />` T <br /> ..r tho.a• Ix~nmt. dinw•U~ rrspmeihle for K:nhrrin>; the infnrm:nion, the inRvmmion I <br /> .uhmitMd is, to the Ix+t of my Anoxlydgr and tx•lief, true. ucruratr, attd complete. $IGNATURE~OF PRINCIPAL EXECUTIVE <br /> 1 am uxure thm thane an .i~nihaant prnalticy for whmitting fal.r inf„rmaliun. <br />r Am,xin <br />latiu <br />~6 <br />! f <br />d i <br />i <br />ai <br />l <br />di <br />h <br />d <br />t f QFFICE 'OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED ty ~~ <br />mpr <br />..mmen <br />o <br />y; <br />o <br />n++. <br />inr <br />u <br />nK t <br />e p..-. <br />, <br />uta .m DE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />' - .-r^• T ~~ ,_,` ~ PPI_jt`n t-np .,-•~1n4'R• 24NR PRFCrP EVENT; <br />EPA Form 3320-1 (Rev. 3,t99) Previous editions may G_~ ^se : Toll tS 1 ~-p3I'L fOFIII. PAGE OF <br />