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PERMITTEE NAME/Aj7DHESS(!~ frrtillyXw./LorN/M /n1O4'~) • NATIONAL pOIIUTANT gSCHMOE ELIMINATION SYSTEM NPOESI <br />NAME DISCHARGE MONITORiNO REPORT /DAR! <br /> ~' . <br />ADORE53 ~I "~ `~ ~~ ~ ~J <br /> <br />' PERMIT NUMBER gscHAROE NVM!!ER <br /> t_ISAL~E rp ~~ <br />FAaurv DSiL~E C~ORTH « S_~UTH E`1?PJE' MONITORING PERIOD <br /> - =; PAi` 3 S~~DE YEAR QA YEAR DAY <br />IOCATgN <br />_SiJN <br />I_. KIDi~E~'. V F FROM TO <br />Form kpprovtid <br />oMe Nn zaao-oppa <br />I <br />NOTE: R~~d {r>•trvctllx» bef«~~ eomplNMp thl~ corm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• UFNCY <br />FREO SAMPLE <br /> EX O <br /> AN~YSfs TYPE <br /> A~IERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> :, <br />-- <br /> PERMIT _ .. '-- <br />~J i - - - IL-'.~' REQUIREMENT t'1If,i: ~~'~._-r~ I <br />MAX I.'•"_ <br /> <br /> SAMPLE <br /> MEASUREMENT <br />rte,; ~ <br />: - - <br />_ <br />,Ir~~ .., J t,, I i,. <br />L d r ':. r, ~. ~ ir1` <br />1! PERMIT ,rr. ~ <br />I+,. _,T MA <br />. <br />.. REQUIREMENT <br /> <br />`' <br />" <br />~ SAMPLE <br />'!J TREK <br />(i~fE~l <br />( FL <br />ANT <br />_ MEASUREMfNT <br />ti~ <br />~~O 1 <br />~ <br />_ <br />.. <br />PERMIT <br /> <br />. r ~ or ~~ I r <br />rLUENT ~RiU_:.~ ~-1L_ <br />' <br />,t, ~ <br />::: i.. i L" iL , i~i's: <br />~~ a v •i~.sl <br /> REOUIREMENT <br />_,L .: L_ r:. cti y cti <br /> SAMPLE <br />I i Si <br />;AL <br />. MEASUREMENT <br /> ,.. _ <br /> <br />t <br />1J1=~J r _,~•~.JE= - . <br />, <br />: Pf RMIT <br />• t`. ~T f`iAX <br />_ _ <br />.. _ _ <br />_. <br />. <br />. REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMEN'C <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <br /> <br />NAME/T1TLE PRINCIPAL EXECUTfVE OfFICER 1 nn~l~ u et prn^ 1] o ^~ Ih^1 uN dotrorrlrsl ^ru1 ^11 ^rt^rhmenle wrrr <br />TELEPHONE <br />DATE <br /> prrp^rnl undrr rw1 direrlbn or t^rprr.tlan In ^ccord^nn w11A ^ sr^tem ddtned I / _ <br />0 I1 0. ~ ~ G i r^. ; ~- t' , ~ C to .a,lrr to^t ~..nn.e penannN pwr~+r t^tMr ^ne e•^fu^te Ine lnrorwr^tton <br />l <br />d <br />d <br />I _ _ t, <br />'~; ~ <br />: ' r <br /> ^npmltle <br />6rr <br />twr m1 <br />rpu <br />rr of ue prr^orl tx prrsan wAo m^n^te the rTllrm. - <br />/ <br />-1 •- ..• c ~~ <br /> <br />\ <br />or ItIpR prnero dIrMIT rvpoedAk for t^IArrtnt IAt Inrornullen, ue Infonn^lbn . <br /> <br />~ ~ <br />r `L :~ I'. ~ wbmlued Is, to ur Aal of m~ Yne.tedtr ^nd EeMrr Irar, ^r~rnlr. ^nd tompktr. - <br />1 <br /> t ^m ^~^re utl tArrr ^re fftnlflunt prndrln ror ruemltunE LNe Infnnrullnn. 610NATt1RE Of MtNCIrAI EXECUTIVE <br />TYPED OR PRINTED lncl..din= IM podplUll of floe ^nd Impn^onmenl for knu.Int .lol^unri< OFFFCER OR AUTHORIZED AOENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANA i IoN yr rlnT nv~A t wtvs lIfI/NIOCI M ~rncnm~nE~ non/ <br />EPA Form 3320-I (Rev. 3/99) Previous editions may be used. TF1151S ~ 4-P8rt (OETII. PAGE OF <br />