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rERMITTEE NAMElADDRESS pwetri F«M~yN../L«aren (/D~G-wer) <br />NAME <br />ADDRESS <br />rel. ~ -`- <br />FACILITY <br />LOCATION <br />V L O 1 <br />~. F. <br />NATIONK iOILUTANT DISCHMOE EIIMINATON SY 9TfM (IVPDESI <br />DISCHARGE MONITORING REPORT (O RI <br />PERMIT NUMBER ascHAroc Nu+~sEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO OAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />J<: <br />NOTE: R~~d 11>.tfuctloM b~iw~ compl~th-p thb torn. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX Fx[ovENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANALrsrs <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT ;•' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ J <br />' <br /> REQUIREMENT .. "' ` _ •'i' .. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ,_ ' <br /> REQUIREMENT .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ . <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br /> REQUIREMENt '"'~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT `~' ' <br /> REOUIREMEN'C - ~ , - ~ <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br /> <br />R , <br />EQUIREMENT <br />NAME/77TLE PRINCIPAL EXECUTIVE OFFlCER ' """` " " pt""~ ° •' Thal Ihb docutntnl •ne as ^IlachmenU wen <br />TEIfPNONE <br />DATE <br />prepared under m~ dlrecl{on w auyer•blon In •ecotdanrt with ..ftlem ddi^ed <br />to sawn that aoaXfied ptraonnd yroOeAr i•Iher and trah~•le IM Inform•Ibn <br />•ubmltted. bred on m7 Irpulry of Iht ytnon of penom who m•n•it IM fyfltfn. <br />w those penas Mrectl~ rayolerbk for inhMni the Inform•Ilon, IM inform•tlen <br />- auemllted b. b the seat of m~ Ln•w4dit and belkf, Ins, •mrnle, and tonrpkle. <br />Nfl <br />i14NATURE OF -RINCI/AL EXECUTIVE <br />I Ih <br />l <br />t <br />n <br />Itl <br />f <br />e <br />lltt <br />ki <br />I <br />f <br />1 <br />d <br />f <br /> en •n a <br />i <br />t•n <br />Oe <br />• <br />ea <br />•rn •w•n <br />r• <br />or r <br />m <br />~ <br />a <br />r <br />n <br />onnatlen, <br />TYPED ~ PaM~1TED Incfudlni IM porlbltllr of ftne and linyrfaonmenl fw Anowlni .Id•uorea OFFICER OR AUTHORIZED AGENT COOS NUMBER YEAR MO OAY <br />COItitMENTS AND EXPLANATION OF ANY VIOLATIONS /R•fer•nc• raM arrschmenfs hrarel <br />I = °orm 3320-1 (Rev. 3x99) Prevrous editlons ma <br />This is a 4-pan fo~1n. PAGE OF <br />