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PERMITTEE NAME/ADDRESS!/ndxde tt'eciGrr NasdLrradun iJfhjJerrnrl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />NAME :~; DISCHARGE MONITORING REPORT (OMR) <br />ADDRESS _' tJ i`< <br />(S<<: PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY i7l.ii i ZCN !' YEAR MO DAY YEAR MO DAY <br />LOCATION i A FROM TO <br />LAi'3CE WADS, - ~- , <br />Form Approved- <br />OMB No. 2040.0004 <br />r - FINAL <br />Sit'~i~iINE T':tNO TP. FI3 ?Q TUT'TL.E D <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />f. SAMPLE , <br />c~~ MEASUREMENT <br /> PERMIT .. < ., .. ,* :: ,. -; ... - _ ; T. = ~ . - _. <br />_ _ REQUIREMENT /~VG <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ...:; it ..a ;; ~<;: i-'f:,;? ~ f3 Ef'UF'. r . <br /> REQUIREMENT ;:";t' ~ ~-,`J.- ;CAI i. Y !'I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - . rr :>.i.-•.. ..~.,.; ;~ :, F.~='CiF','3' RFi'tl>:•'.T <br /> REQUIREMENT ",_•.ii;?A AVG ::1:=:IL's' t~l, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ .. ~ ..; :; /-, _ir.,r L <br /> REQUIREMENT aA ` i.. ~'' <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 1 certiry under pr•nxlq ++tmw mat mi. d+a umrm and au auaahmrntn were <br />a <br />d <br />d <br />di <br />ti <br />• <br />t <br />i <br />d <br />i <br />h <br />d <br />i <br />d _. TELEPHONE DATE <br /> er my <br />on ur supa <br />ance ss <br />prepare <br />m+ <br />rec <br />n is <br />tm <br />n accor <br />t <br />a s~ <br />rm <br />rs <br />~ne ~ - - <br /> lu sewer that yualifird prrwnnel prnprrtr Knlher and rsaluntr tIK inrorn+utian ` <br />-- - ~ , <br />- -- - <br />' .ubmiued. Based on ms inyuin of Wr prrwn or perwm Mho manxAe the satrm. <br />nr th+we persotrs direNir respmcibk for >LatherinR the inGxmuti+xt. the inrormatiun ' <br />~ ~ <br />- <br />, <br />- <br />' submitted b <br />to the bent or my Anoakdge and belkr <br />trot <br />urcurate <br />and compktr ~~ ~ / <br />; . <br />. <br />, <br />, <br />. SIGNATURE OF PRINCIPAL EXECUTIVE ' - • <br /> <br />TYPED OR PRINTED 1 am snare that there urc si~n~a~fnt prnaltic. fur submitting false informntina, <br />includir+g the p+nsihiliW ur fine and impriamment roe knnssinR sinlWi+ws. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY vlVLanVlvs (Heterence an attacnments nere~ <br />EPA Form 3320-1 (Rev, 3199) Previous editions may be use <br />