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PERMITTEE NAME/AODRESSp,.eVyFrsNryNfsw/L-ecNlnsl/D~f.wsq <br />NAME <br />. <br />ADDRESS .: ... .. _ .. .. - - <br />-SAS:: CG d1~1b <br />FACILITY .; l lJ )r :i O k l' h ~ 5 C ti T ti C! j h. J <br />LOCATION FRLI~Aii~: CC al~lo <br />Form Approved- <br />NATIONAL POLLUTANT ascNAROE ELIMINATION SY9TEA1 NPOESI GNIB No. 2040-0004 <br />DISCHARGE MONITORINQ REPORT /O R1 <br />J-tt , <br />PERMIT NUMBER ascNAnaE NuMeER _ T - <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: R~~d IMtntrticx>. b.for• comnlaint7 thlt form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREO <br />NCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAlrsls TYPE <br /> SAMPLE <br /> MEASUREMENT <br />_ PERMIT . ~ ' - r~. i C.. i _ '.. <br /> REQUIREMENY ~ } : . N <br /> SAMPLE <br />' <br /> MEASUREMENT <br /> PERMIT ,. I ~~ ~ ~ i <br /> REQUIREMENT ~ ~ I i I <br /> SAMPLE <br /> MEASUREMENT <br />1 PERMIT .. ., - <br />..:. t ~ : `i <br />_ / <br />,: <br />_ REOUIREMENT i Y : a 21• <br /> SAMPLE <br />' <br /> MEASUREMENT <br />~ <br />_ PERMIT ~ ~ r ' ~ ~ ~ U ! : (~ (} <br />~ <br />/ <br />~ REQUIREMENT ~ <br />,.. <br /> <br />. ... SAMPLE <br />~ _ . <br /> MEASUREMENT <br />..- l ~ U - ~ i. ,: _ :." ~ ' <br />y <br />r, r• ~, <br />J 1 _ REQUIREMENT 1 .f. !~ ~ <br />f <br />:~ 1 <br />i . _ •~'.. _ : _.. SAMPLE <br />1 MEASUREMENT <br /> PERMIT :. r ~ -. ~ PC) R T ..: <br />. REQUIREMENT _ ., I L Y :" X <br />.. SAMPLE <br /> MEASUREMENT <br /> PERMIT , _- , ~ Y V i 1 e~ <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER ' """' " ` pe""' ° 1iw1h" `"" d""'"'r"' fne All ^IlKhmenb weR <br />prepAred under mr dlrtcllon or wpenlflon In srcordAncr wllA . srslem dat[ned TELEPHONE DATE <br />-. Io Apure IAN ouAhtled prnonnel properly [NAer Ard ernluAte IM InfnnnAlbn <br />uA <br />ltl <br />d <br />d <br />I <br />i <br />B <br /> s <br />m <br />e <br />ssre <br />on mf <br />nqu <br />. <br />ry of the person or persom wM mAn.[e ttx sysurn, <br />a th <br />er <br />o <br />dlr <br />tl <br />rr <br />tbk f <br /> ole p <br />ro <br />ec <br />~ <br />fpern <br />s <br />or [NhMn[ the InforwuUon, the InformAtbn <br />M <br />f <br />b ~ ~ = ~ - _ .~ <br /> fu <br />rilted <br />. to the Heft o <br />m~ knowfrd[t And DeMtf, Irve, Af(11r1te. And compklr. - ~ '~ G ( <br /> <br />I ^m AwAre UAt there Ant s1[Nflcinl penAltla for submltNn <br />fAlee Info <br />tb <br />810NATURE OF PRINC1 . <br /> <br />TYPED OR PRINTED <br />ww.•..~..~.. ..r v nAI AC AAIV \/IAI [ <br />ntsA <br />n, <br />I^~~t^[ the polhlUtr of nne AM ImpAwnmeN for Lnowtn[ .IolAliots>. <br />ATIl1Aln _ ______ _ _____ ___ PAl EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />CODE NUMEIER <br />YEAR <br />MO <br />OAY <br />.i.n.i.c~. ""'ON ;LZ~h-.;,T' LIt'IT~iluf~s wN' .` (~f.r.Ll+ h raEC:IE.t11ct1", LC.~..... - _,; ~CI_ i ?C cG;.:.~, i.r i <br />f F <br />EaA Form 3320-1 f Rev 3+99~ Previous editions maybe useA This is a 4-part form PAGE OF <br />