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PERMITTEE NAME/ADDRESS r/nrludr FtrciGry :Vasa/f <br />NAME <br />ADDRESS - - <br />1~~ , <br />FACILITY ~ [ ~ r; ~ p; t i , •. <br />LOCATION L,~ <br />~At'JCE WAt3E, 3` <br />Form Approved. <br />OMB No. 2040-0004 <br />/"` ~- <br />NOTE: Read Instructions before completing this form. <br />anon iJlJiJjrrenrr NATIONAL POLLUTANT DISCHARGE ELIMINATION SVS7EM ((NPDES) <br />• DISCHARGE MONITORING REPORT (DArIR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />C a YEAR MO . DAY YEAR MO DAY <br />FROM TO <br />I JET. MAIVAG <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r- , <br />- REQUIREMENT ~ P't I r,t I "IUCi '- `i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . <br /> .REQUIREMENT ~, :,, _ ~~•,".'.-t~; ~i~ ~~ • <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a r.. . r, .. _ , - , ,:. ,. <br /> REQUIREMENT ' ~ _ - ,- <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT - :: +; .. <br />' " - <br /> REQUIREMENT .. i;'; ~ i._ I' rr <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~. - <br /> REQUIREMENT ` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />. ~ REQUIREMENT ~ ~ "~ ` -, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : c. I I .. >. .. ,. <br /> REQUIREMENT f~ ... ~ ~ ' '- <br />NAMElfiTLE PRINCIPAL EXECUTIVE OFFICER I rrrtif~ under penalty 01 ~w that this d.x~untrntrnd all otmchnnnls Mrn <br />d <br />i <br />~ <br />d <br />i <br />h <br />d <br />i <br />d 1 TELEPHONE DATE <br /> rs <br />prepare <br />under m. dirccl <br />un or wpen i+i~m in an <br />or <br />ance w <br />t <br />a +ptem <br />ttne ~.___.,._ , _„ <br /> to as+m'c that yualiftrd perwnmrl properly father and esaluatr the information <br />---,_ submitted. itasrd nn m. Inquire of thr prrwn ur prrunts who matwgr the sr stem. ~ ~ ~ ~ J% ~ ~ <br />~ _ or th~~~ prrsrms direcU~ mpnn+ibk fur gatbrrink the infunnaUon. lbe information -~ <br />~ <br />~ <br />. to the best of m <br />knoMtrdRr and befit! <br />true <br />aceurntr <br />and eomplete <br />+ubntitted i <br />~, <br />~ <br />~ <br />~~ _ _. <br />~ <br />. <br />t <br />~~ ~ ~' ~ - , <br />, <br />, <br />. <br />, <br />7 <br />b <br />i <br />(k <br />t <br />l <br />i <br />f <br />b <br />i <br />ti <br />f <br />ki <br />i <br />f <br />ti <br />1 SIGNATURE OF PRINCIPAL EXECUTIVE , , <br />-~ <br />' <br />TYPED OR PRINTED • orma <br />am a+sarr that t <br />rre art s <br />Kni <br />an <br />prtta <br />t <br />es <br />or su <br />m <br />t <br />ng <br />a <br />r <br />n <br />ot4 <br />includln{t the pu>aiMliq of 6nr and imprisonmrnt for Amwing ri~dntian. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />-;c <br />EPA Form 3320-1 (Rev. 3.99) Previous edd~on< r„3y be used. <br />Thi. iti a -3-Hart iilrm <br />~~ <br />