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PERMITTEE NAME/AOORESSp~.~r~rF.evbyN..r[,e.rrw.l/D~.....r) <br />NAME <br />ADDRESS ., 1 ~ ... t _ , , , L .. <br />. dGX i4iU <br />. ~AUF: CL; Eii~tb <br />FACarTY ~ L U L ti Ur, ~ a t :: O J'T t: X41 N z. <br />LOCH TION <br />F~ALiLhLt CU G~Sc:G <br />. ~ C r: r r t r r r. e. :r r <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPOES/ OMB NO. 2040-0004 <br />DISCHARGE MONITORING REPORT lOMR/ <br />PERMIT NUMBER ascHAROE -ruMaER _ s : ~ C . <br />MONITORING PERIOD - - ~ ' ' •! ~ r <br />YEAR MO DAY YEAR MO DAY _ _ <br />FROM TO <br />NOTE: Rod Ir,"tructior» bafw• coinolatlnp this form. <br />;. n <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. rREOUENCr <br />SAMPLE <br /> of <br /> EX ANAIr~s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ • - <br />~ t ^ ~ <br />- - - <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />~ ~~ <br />~ ~ / <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />:-, J -. PERMIT ,... -.~v -r..-,r„ .Li> _ ~./ - i- <br />. REQUIREMENT . <br />, <br />i i <br />,, ,_ ~ <br /> <br />y ~ - y SAMPLE <br />` <br /> MEASUREMENT <br /> <br />1 PERMIT ,. <br />-, ; ~ <br />~' ~~`.. <br />- v ~. - - <br />c ~.,' ~, <br />, ~ / <br />r• ~ r <br /> REQUIREMENT . <br /> <br /> <br />- - SAMPLE <br />i <br />- <br /> MEASUREMENT <br />,. _ PERMIT ...... +rYic%y: ^ t t C ;.. ~. v ;, Y ~ i P, r _ <br /> REQUIREMENT <br /> G :.' <br /> <br />r <br />~ SAMPLE , <br />. <br />. <br />... .. MEASUREMENT <br />i PERMIT r G :•.: t: G F O ii Z ~ ~ ` ? t <br />L ~ <br /> <br />te REQUIREMENT - <br />~~. .r <br />~ ~ M' Y <br />y SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT . , .. " ,. . ,. .. , -. ~ .: z :~ L 't ~ ~ :: ', ., <br />REQUIREMENT <br />.~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' """~ ° " ve""y o 1." `"" thh dorume"""d'° "t.cnrrrnl. "'^ TELEPHONE DATE <br />prepared under ml dlrerllon or superrfflow In sccordsntt with ^ f•rtem de! jntd <br />to more ten qushfled perwnnel propeAf plher and e•slune Iht Infernutbn <br />- frrernlued. a..ee en mf Ingw~ or ore perwn or perwru .hs nun.je the :item, <br />or those pereem dlrecllf raporedbN for jalheAn j the Informstlon, the Inforrrrtron <br />wbrrtltted Is, b the best of me knewled je srd DeMef, Irve, scairrsrr. and compkle. r <br />I sue."^re ust men .R,l jdnc.rt pen.rna ror,~rertitnn j nr.e l"ror,n.non <br />61DNATURE OF -RINCI-AL EXECUTNE <br />TYPED OR PRINTED , <br />Inr~l"i tAe podblNtf of floe and Irnprrsonrnent for trxrwin j •fd.uorri OFFFCER OR AUTHORIZED AGENT p' ', NUMBER <br />CODE YEAR MO DAY <br />COMM[N 1 S ANU [Jlrl.nn~ t wn yr ore r .rv~n ~ rvr~a trt~i~r~nc• «i ~rr~cnmmra n~rrar <br />EPA Form 3320-1 (Rev. 3/99) Previous edfions maybe used. ThIS 15 8 4-PBrI fOrlil. PAGE OF <br />