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I'ERMITTEE NAME/AC>ORESSp~rrF.rurryN.+/Lxw/al/D~..wv) <br />NAME <br />- <br />ADDRESS _~ „ r ... ,. <br />1 _ ..+' 1 ,l ~~ <br />~J:i 143:: <br />~:i6Ul; C(: di~s:c. <br />FACILITY <br />~Illc Ni'::'1H 6 SL)UgH t:i~c::i <br />LDCATION <br />FAiiSni:t Cif tll:;tb <br />:nrv a _ ~rrrn~c v-n- <br />NATION AI POLLUTANT DISCHAAOE fLIMINATION SY9T EM /NPDESI <br />DISCHARGE MONITORINQ REPORT (DMRI <br />PERMIT NUMBER ascHAnoE Nuweea <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br /><1 i ^i (: 1i <br />~JGI~Ft <br />F - F. <br />Pt:riL ~ <br />Form Appro.ec <br />FMB Idc 2040-0G0 <br />-_,. - i <br />.s <br />NOTE: R~~d Imtructltxw b~iw~ t.~tiipbtlnp thl~ ftxm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FnEauENCY SAMPLE <br /> <br />EX OF <br />YP <br /> ANALYStE T <br />E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br />- ~ ~ PERMIT <br />- . <br />- - - - <br />• . - <br />.._ . . <br /> REQUIREMENT . N <br /> <br />'' r " ` !' " SAMPLE <br />~ ~ •- ~ <br /> MEASUREMENT <br /> <br /> PERMIT <br />J ~J <br />/ <br /> REQUIREMENT <br /> <br /> <br />` SAMPLE <br />• <br /> MEASUREMENT <br />- PERMIT ., ... _ i L r 1 ., ~ :. / ., . , . <br /> REQUIREMENT <br /> r , > ., a <br /> <br />' `• SAMPLE <br />~ ` <br /> MEASUREMENT <br /> <br />' <br />- ~ PERMIT f ;, .. -, .. >'r1;, t •;.~, <br />~ ~• "~~ <br />i - <br />_• ~ .- / <br />: F n <br /> REQUIREMENT <br /> t• ? <br /> <br />• SAMPLE <br />' <br /> MEASUREMENT <br /> PERMIT _ <br />•, ~,•~ ~- <br />~ '_ , _ <br />.. ~ •i : " <br />.:r ~ ._ <br /> REQUIREMENT <br /> <br /> <br />- `• ti `~ •- L - SAMPLE <br /> MEASUREMENT <br /> <br /> <br />J ~ PERMIT <br />,. r ~ - <br />t ti k U it . <br />~ :- t r I ` <br />' <br />_ . <br /> REQUIREMENT <br /> <br />-" ` '" SAMPLE I ~ <br /> MEASUREMENT <br />,, <br />-- <br />PERMIT - - ~ <br />-- ~ , ., is E ~ ~ - - _ <br />REQUIREMENT <br />h <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER ' crn"' " `r pe"e'y o Irw the thb document •nd dl d<Khmenb wrre TELEPHONE DATE <br />prrpentd uwder my dlrectlon or wper~flon In raecord~nte r11h a syrlem dtll~ned <br />to a,sure the quraHfled penonnN property tether ^nd e. dude the Inf"rnv,tbn <br />tabmltted. bred on my tnqulry e( Ifte person a peraoro who trtnnge the rntrm• <br />j o, rhos perswte directly rnpordbk la ~~thertrq the Informrllon, the Infornrtlon i "'r , <br />• <br />wbmlllyd b. to the bnt of m~ knowied~e end beMtf. Irve, KcL nte. ^nd compkle. - .. ! - ~{ <br />1 •m....n lhN ihrre rye stpnlnc.nr ~ndnr, !o. rvbmltllnR letx Inrn.metMn EIOHATURE OF t'AINCtVAI E7(ECtITIVE <br />JTYPED OR PRINTED ~n.lwinr~h.pr,~n~u:,•,rnn..n.inn,Pr~N.n.,.,~r~•,k,,.,.~nf,~~l.u.,n~ OFFICER OR AUTHORIZED ACENT CODE ~I"t~R YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRIII/I!!CI sM •tt~chm~nt~ h~r~l <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. TI11S IS d a-p8fl fOf-il. PAGE OF <br />