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PERMITTEE NAME/AODRESSp~i.f.rWyN../Lorwlw'1/Dlpwwv) . <br />NAME <br />ADDRESS <br />• ~~ . .lUb 1 4 .i v <br />-•~ISbDE (:U bi <br />FACILITY <br />~'~iDt; .~C,Fti17 ~ : V~TI°. ?11tf~J <br />LocAnoN <br />r'bi1:5AGt: LG fit <br />/1 li f [ 1 t~ I <br />Form Approved. <br />NATIONAL POLLUTANT OlSCNMOE ElIMIHATION SYSTpN /INPOESI OMB No. 204Q-0004 <br />DISCHARGE MONITORING REPORT IOMR/ <br />., i M~ <br />PERMIT NUMBER ascNAnae NuMeen <br />MONITORING PERIOD ~ i ~ E E ~ <br />YEAR MO DAY YEAR MO DAY <br />FROM TO - <br />• c <br /> r <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. fREOOUfNCY SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAIr~s TYPE <br /> SAMPLE <br /> MEASUREMENT ~ • <br /> PERMIT <br />_ REQUIREMENT .- . . -' <br />~~ -• - + . v _ ... _ 'T f . i : J <br /> SAMPLE <br />MEASUREMENT <br /> , <br />_ PERMIT _ <br /> REQUIREMENT - = ~ ~ - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> P <br /> ERMIT <br />REOUIREMENT <br />_ _, <br />. ` <br />n = c ~., ~ 'i <br />!. i, r i <br /> ~ , <br /> SAMPLE <br />ASUR <br />M <br /> E <br />EMENT <br /> <br /> PERMIT <br />• <br /> REQUIREMENT <br /> ,. <br /> SAMPLE <br /> MEASUREMENT <br /> P <br /> <br />. - ERMIT <br />REQUIREMENT _ _ <br />~ <br />` `': ': <br />- ~ <br />~ <br /> , - <br /> SAMPLE , , <br /> <br />. - ~ MEASUREMENT <br /> PERMIT <br /> <br />r " ~ <br />REQUIREMENT` <br />l .. r ) <br />, r_ <br />.. ... <br />_ .. L Y <br />' : ~ ~... <br /> <br />_ SAMPLE ~ <br />~ .. ... <br />MEASUREMENT <br /> PERMIT <br /> <br /> <br />~ _ _ <br />• ~ <br />: • <br />a `~ _ <br />r J <br /> REQUIREMENT - <br />- <br /> <br />NAMElf1TLE PRINCIPAL EXECUTIVE OFFICER t "^'t/ ° `r pe"` y o b. thN Nb dnru ment •nd .n ^uKhmenta +rre <br /> prep.red under m7 dirxtlon or wpenl~on In .tcord.nes with . srltem dd~nrd <br />to ataure IAN <br />u <br />Nf1M <br />l TELEPHONE DATE <br />_ _ q <br />. <br />personne <br />Properl7 [.tber .nd er.lu.le Ibe Infw~n.tbn <br />- fobmltlM. Geed on m/ Inquiry of the ptrson or person. who rrun.~e the r)slem, <br />1 ~ a Ihox prrsem dlrertl/ refpordbM (or (Nherlrl~ the InfonnNlr,n• the Infornrlbn <br />fubmllled b <br />b the bet of m <br />lnor4d <br />d ~~/l.` • <br />~ <br />~ <br />_- _ <br />- y <br />. <br />~e .n <br />betlef, IrLe. .rev nle. .nd rompkle. <br />l .m .+.r. UL1 Ihere .re f1~rJnont <br />enane r <br />bmint <br />h y - '• <br />y' <br />~' <br /> p <br />or wl <br />n~ <br />kee inrormNbn, <br />I <br />d 610NATURE OF -RINCI-AL EXECIlT1VE <br />TYPED OR PRINTED n <br />udlnt the podblllt}• of Ifne.nd Imprisonment for knorln~ .Id.UoelL OFFICER OR AUTHORIZED AOENfT A A NUMBER <br />CODE YEAR MO DAY <br />~n....clurc •lufl LYPI •NITIAN AF •NV VIAL eTlniuc rc_i____.._ _rr _.._,.~___._ .___, <br />EPA Form 3320-t {Rev. 3199) Previous editions may be used <br /> <br />This Is a -3-part forrn PAGE OF <br />