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PERMITTEE NAME/ADDRESSpnrv~.irtbryN../L«uton(/D~Qi.rnr) <br />NAME <br />ADDRESS _ ~ . .. ,. <br />• . ti (~ X 1 ~ l <br />~~ADE .:c tS,~~~ <br />FACILITY' .; 5I D E ;~ a ... ,. _ :, ., i ,. :: i N c 5 <br />LOCATION <br />PaLl::itl,l. L;L J15a <br />NATION AI POLLUTANT DISCHMOE ELIMINATION SY 3TEM NPDESI <br />DISCHARGE MONITORING REPORT ID RI <br />PERMIT NUMBER DISCHARGE NVMSER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />"1 1 n <br />(5~ <br />gym Appro,ed <br />w+e r;o ~c~~-~ooa <br />NOTE: Rud Ir~t-uctior» b~lw~ compl~tlnp thb 1wm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> of <br /> EX µ~yyyg TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t; .. - • • <br />~ r. i t . b _ i <br />f REQUIREMENT _, 1, n i r ii <br /> SAMPLE • <br /> MEASUREMENT <br /> PERMIT / i- :... <br /> REQUIREMENT <br /> .. L.; t v v ... ! Y ~, t~ ; ii <br />• SAMPLE _ . ~ <br /> MEASUREMENT <br />. '+ ~ ~ ., PERMIT . r ..+ t~ . , , ,. C . '1 L . / .. ~ _ <br />' ~, v : i ~ REQUIREMENT J n l 1 Y !' ', :". C ~! ~C <br />_ ', ~ ~ ~; :.. i. SAMPLE _ <br />} MEASUREMENT <br />_ PERMIT - .. ~ ~. J (J 7 V t• •. ( / : I1.r•. L <br />t REQUIREMENT ~. ~ ,_ 4 ~ Y :" <br />tit <br />t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... ~ t ~ ~~ ; 1 . ~ ~ ' . <br /> REQUIREMENT <br /> r <br />- _ <br />~ SAMPLE ~ <br /> <br />., . MEASUREMENT <br />1 PERMIT ~...FG:.. rE:FO:'i.z ._ .. -~ - ~ .. .i. <br />~ :: ~, ., i. REQUIREMENT s U ~ A ' K i I Y ?', X <br /> <br />.. _ SAMPLE <br />I <br /> <br />• ~ '- MEASUREMENT <br />PERMIT ... r t ~ ) 1 ~ ., .. <br />REQUIREMENT <br />t nrttte ^ er pen. t~ o Ir+ tb.t Nle document ,nd ^il ett,rbtnenl..ere <br />NAMElT1TLE PRINCIPAL EXECUTIVE OFFlCER <br />TELEPHONE <br />DATE <br />prrp,rrd under mr dlrectbn or wperiz•on In Ircord^nce .i1A , ^~etem dr.lEned <br />Io tmnre IbH qu.Mfkd pe.wnnel properll [atAn ,nd r.YU^te the Inferm.llon <br />--~ -- wbmllled. bred on m) Inquiry o! Ilte penou or per.om .bo Irrna~e IM ^yflem, <br />or lAOlt <br />ecforo dlr <br />tl <br />otdbi <br />f <br />rn <br />r <br />^lb <br />t <br />I <br />b <br />r <br />T <br />p <br />er <br />p <br />e <br />o <br />~ <br />er <br />n~ l <br />r <br />n <br />orrrullow, IAe Inroneullon <br />mblNlted !f <br />to llte bet or m) kno.kd <br />e ,nd beUef <br />INe <br />t <br />n <br />d e <br />kt <br />, <br />~ <br />. <br />. <br />ccu n <br />e. ,n <br />omp <br />e. <br />1 •m,.,n UN Ibere,r: slENnuN pendtle ror wbmluln~ bbe Infonrrtlon <br />fIONATVRE Of -RINCI-AL EXECUTIVE <br />TYPED OR PRINTED , <br />Includi"= Ibe p".a61ury of nnr •Id ImpMonment for Lno.in~ .Id.tlotra OFFICER OR AUTNORI2ED AOEF(T CODE NUMBER YEAR MO DAY <br />COMM[:N I S ANU CJIrLAnA I IVn yr nn ~ •IVt.n t Ivna In teror~nc~ tni ~tucnrnmta n~rq <br />... , , t~-t;tiT Gl:~i;c3~, SUIIJEC2 1C: bI,E~Eb Cf E`CCE <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. TI115 IS ~ ~}-PBEt fOfiTl. <br />.. .f G <br />