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PERMITTEE NAME/ADDRESS(/wcvirsrWryN~./!,«.new(/D~...nt) <br />NAME <br />• t3UX i4~t, <br />-.SAD' ~.(~ bi5it; <br />FACILfTY , : j j U ~ n c.' :: 'i ct ;, S U [J ~ r: ly I N z ;, <br />1OC'~~ i'bLI:~niG 1:::, u1516 <br />Form Approved. <br />NATIONAL VOILUTANT dSCHMOE ELIMINATION SYSTEM NPDESI CIMl3 No. 2oao-ooo4~ <br />DISCHARGE MONITORING REPORT /O Rl , <br />.... _ ~) <br />PERMIT NUMBER astHMOE NUMSEII _ _ ~ ` t+ e ~ A <br />MONITORING PERIOD T ~ `~ A 1- ~ f• t ;` ti <br />YEAR MO DAY YEAR MO DAY ~,;_~ <br />FROM _ TO ' <br />NOTE: R~~d Ir>•tructlora b~1w• oompbtlnp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, R-EOUENCr SAMPLE <br /> of <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALrsls TYPE <br /> SAMPLE <br />1 <br /> MEASUREMENT ~ <br /> PERMIT . - `~ . 0 ~ t ~ : : . _ '. <br /> REQUIREMENT <br />trjMli" , <br />^'il.fi. <br /> SAMPLE ~ <br /> MEASUREMENT <br />.. PERMIT ... ,;, r. c r :,. ! ~ . :+ : <br />~ / ~ ~ <br /> <br />REQUIREMENT . - <br />_ SAMPLE <br /> MEASUREMENT + <br />.- PERMIT ~=~ ii~:k:::.: .. 'L2,:IP, ~tl;. <br /> <br />REQUIREMENT .. <br /> <br />tit <br /> <br />t: , <br />~ _ SAMPLE ~ <br /> MEASUREMENT <br />'~~, PERMIT r, ..rl:~.i :i;~:rr~tS r.rt. -. .:.+,.[•.. ,•4,1=! ~ct1Y ~. <br />t~ <br /> REQUIREMENT j ~, n , ~ j. y P; X <br />_ SAMPLE i <br />1 MEASUREMENT <br />_. _ PERMIT ci-GhT ~ c , n <br />LY <br />VI~Ct• <br />_ <br />~ REQUIREMENT I i::; ? :', r Y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENTC <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' Ce^"' " r v"•'7 0 lew Chet ihN dtitument end ell •ttechmenu were TELEPHONE <br />d DATE <br />prepare <br />under m~ direribn or fuper.hlon In eccordence with • s]flem ddjned <br /> <br />~ J ~__ <br />' to enure that au ellned p•rwnnti propeA~ jelhtt •nd t, eluelt the Infmmellon <br />suhm111ed. 6~cd t.n m~ Inquln of the perwn a prnonf who meneje tht tntem. <br /> <br />~ <br /> <br />- er Ihott penom dlrecne rvporgit>Ie fa je[hMn j Iht Informetlon, the In/ormetlon --,+:- <br />I / ~' <br />~ <br /> <br />- suEmltttd If, b tht hell of mr tnowkd je end trellef, true, etcante, end complete. <br />1 •m aware Ihel lhtn ere etjnlfkent penNtlet fm wbmlttlnj fetes Infonrutbn, '- <br />s1UNATVRE OF -RINCIPAL EXECUTIVE -- <br />`- <br />TYPED OR PRINTED Indudl"j ~h• podhthtr of nne •nd Imprt•onment (w Anowlnj videtbrs OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />Vl1MMCr`I I.1 AtYV Cnr 6'en r'e r.vr. •+. ~... ..~..-.. rv.e.a Inv wr erncer mr oirwonenwn ra nen ~/ <br />.. .. _ i:~,1uHf! pne:C.il:'. F.Yt,h1 GCCUrt~, SU>rJECT 'LG cE.aL~A CF F~~GF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used <br />Thls Is a •~-pan form <br />