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PERMITTEE NAME/ADDRESSpwd.6irwryN.w/L«.rtowl/p(db.,,,,q <br />NAME <br />ADDRESS _ ., _ ., _ .. ~ .. ., ... ~. .. t i .. .. <br />dV}( 1V.Sv <br />_~•AUc L(. UlS~C <br />FACIIfTY :~jUL i~~iHZh G ;~CUih a'llNbS <br />LOCATION YALl..iLGG L~ b171E <br />=.~ib7 1 _ w Tr ..LL u <br />NATIONAL POLLUTANT dSCHAROE ELIMINATION 5Y5TE/~t IIIVPOE$J <br />DISCHARGE MONITORING REPORT /OMRJ <br />', ., .- w j <br />PERMIT NUMBER dscNAROE NLIMeE11 - r l tin l <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />Form Aap~c~:ed <br />Done do ~aao-ocoa, <br />FROM TO <br />NOTE: Rssd lnstructitxn bslw.,complstinp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANA<r~s TYPE <br /> SAMPLE <br />' <br /> MEASUREMENT <br /> PERMIT r. ~~ t. f',•] --- ~ -t.',i1 <br />- <br /> REQUIREMENT <br /> 1 ~e <br />_ <br />r SAMPLE <br />' <br /> MEASUREMENT <br /> <br />- PERMIT <br />.: i- i <br />., ~ <br />. <br />. ~ <br />~. <br />: <br />~ <br /> REQUIREMENT _ <br />.. , <br />T • V y , <br />1 ~ <br />. <br />. <br />; ~. <br />~ 1{ <br /> SAMPLE <br /> MEASUREMENT <br />1 ~ , PERMIT ~. ,. ~ G . ~ x y >n u .. , (; ~ D Z I : ~ ! ; t. <br />• 1 J . •. <br /> <br />v <br />REQUIREMENT <br />~, ;; ;, ? <br />'~ I <br />•, ~ 1 : ` <br />~ ~ _ ., _ <br />` SAMPLE <br />1 MEASUREMENT <br />" <br />V <br />1 PERMIT CIL~'l.hl ..r"~... :.v :.. ., 4'>r:~~•~. r; <br />v 'i`~lr <br />: <br />, .. REQUIREMENT , .. . <br />` <br />Y 1 <br />, n <br />.~ _ ., ` .. ; <br />.. SAMPLE t <br /> MEASUREMENT <br /> PERMIT .. n ~0 fl1 ...:.., 5 ? 'i 4 ; <br />~ ~ <br />n <br /> REQUIREMENT ._ T _ <br />. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' "n't. " ` pe". tf ° I.. th.t inh docume"t .nd vl "'.~n",<"u `~ <br />R •red Yndff T direatbn or a TELEPHONE <br />P P 7 Per`'yon In .eeord.nae vllh . arstem dnl[ned <br />DATE <br /> <br />_ _ to more Ih^1 qu^11fled personnel Properlf plher ^nd e•slu^le the Infonnatlon <br />. ; tabtnltled. Brad on my Inqulrf of the penmt or prrsons oho nunge Iht frftem, <br /> or thox prrsote dlrectir resporolbk for [^therin[ Ine Infonrullon, IM Informatbn _ _ <br />- <br />1 ~`' wbmltted Is, b the belt of m) kwowYd[e ^M DeNef, Irw, occvnte, •nd compkte. <br />1 ^m s..r< that Iher: ^nr d[nlllnwl ,enNNa for submlttln[ htse Inlorm^tbn, <br />810NATVRE OF F'RINCI-AL EXECUTIVE <br />' ~ ) <br />/ <br />TYPED OR PRINTED Inaitdln[Ihepo.dbultrornne,ndlmyrlwnmentror-nooln[•lol^uoni OFFICER OR AVTNORI2ED AOENT CODE NUMBER YEAR MO DAY <br />wmmer~ t a nrw e..r a_esr.es ~ ~.....,. ..... ....~.....,.... ~.,.......... w...r.....rrr.rrw na•r~r <br />• • . ~ ~ ~ - . 'P,2uH•r, e+i+cCZF. zU~ht GCCUic7, ~UE.;rCT 1L• rCfiLF.A l:F EF,CCf <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />This Is a 4-pan form. <br />