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PERMITTEE NAME/ADDRESSpwrY~rF~eiUryNr.vLerNrew~/DIQI...nr) <br />NAME <br />. , <br />ADDRESS ~ ~ .. ., ... ~ .. , .. ~ t ..... <br />. tsUX j4jV <br />. :: 11iJG C.U b15~:G <br />FACILITY ,) j U .t. N U h'1 K t :, v V 7~ h CI j ti jv :r <br />LOCATION ~Al.j.~t~(Ji `~. ~1JCb <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM ((NPDESI <br />DISCHARGE MONITORING REPORT /OMRJ <br />t - ..:: <br />PERMIT NUMBER DISCHMOE NVMDEII - F 1 <br />MONITORING PERIOD ' <br />YEAR MO DAY YEAR MO DAY <br />Foam Pppro:ed <br />CMB fac 2G4G-GGG4 <br />FROM TO <br />NOTE: R~~d k-~trvctiorw b~1o-• t:ompl~tlny thb Corm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION r1O• F1IEOUENCV SAMPLE <br /> of <br /> EX µ,~y~s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ . b . ~ ~ • .. _ ., _ _ , <br /> REQUIREMENT <br />_ 1 ! <br />:-~: <br />~ _ <br />SAMPLE <br />( I <br /> MEASUREMENT <br />. PERMIT a c ~ t:. . ` .. / <br /> REQUIREMENT ~ ` ;; r, <br />• ,_ SAMPLE <br /> MEASUREMENT <br />. _ c. 1 ., PERMIT , a r ... .~ G r C ii `r ~ <br />y <br />., <br />_ ;t i Y t .• it r <br />r <br />.. U :: ~'± r :.:. ~_ .: <br />REOUIREMENT <br />i f,:, : ~ A ~ <br />_ <br />` r d + <br />~ y .. _ SAMPLE <br />' .. .r',•. .'... . <br />MEASUREMENT <br />~ :, PERMIT 7:i.k G 1 '.LYGt•1 , ., w~t71t%,~A ~a.l:, f r.l~ !._ ., t <br /> REQUIREMENT t ~ <br />T <br />J y ~ i l 1. <br />i i <br />.~ <br />~ <br />• ~ <br />• <br />` y SAMPLE <br />~ <br />_ <br />~ ly F L U MEASUREMENT <br />. 1 1, PERMIT .. .. r ..: n ~ E (, r'~ _ . <br /> REQUIREMENT <br />:t •r r (~ ~ A <br /> SAMPLE I <br />~ <br /> MEASUREMENT <br />• PERMIT ,. :,~ 1: C h r _ _ '~ i Y Y a :: (:.•'. <br /> REQUIREMENT ,. ~ ; ~! rl P - <br /> <br />SAMPLE _ <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFlCER ' cenry . r pen. t7 a L. ma Uh document .nd NI .u•ch.~na .en TELEPHONE DATE <br />pnp•red under mr dlrectlon or wpenlelon In •ccord•nn wltA . e7Nem darned <br />to aeon thN 1u.Nfkd pertwnnel P~WA7 L•iMr •nd e••IuNe the Infernutlon <br />J <br />~ <br />I sabmltted. !.•Id en m• Irpulry of the prnon or penury who m.nKe IM .]stem, _ <br />r~ ~ - ~ er Ihtne prrtoro dlresti7 respondbk for jNAertrq the In-orvn•tloa• IAe In/onrnUoa ~ <br />' ~ <br />' wbmltted b> <br />b IAe bat of m7 tno.ledie ^nd beMef <br />Irvt <br />.rsvnte <br />•nd com <br />kle <br />~ ~ ~ • <br />' <br />, <br />, <br />. <br />, <br />p <br />. <br />I •m •.m IAN Then •n dinl0r•nt pendtle rer wbmlmn~ bbe tnro„nalnn <br />810NATURE OF -i11NC1/AL EXECUTIVE ~ <br />` <br />TYPED OR PRINTED . <br />inrt„drni IAe poalbnit. ~r nnr .nd impr+sonment ror kno.ln~ .Inl.umn OFFICER OR AUTHORIZED AUENT CODE NUMEIER YEAR MO OAY <br />COMMENTS ANl) exr~~n~ 1 wn yr nn r ~rvt.n ~ Ivn~ Irt~7~rmc• sn ~Irtrcnmmrs n~r~/ <br />_ , . _ . , :'t~T CrCCL'r.~, SU;:JEC f 1C EU 6LE tr CF I; FCCF <br />EPA Form 3320-1 (Rev. 3199) Previous edfions maybe used. This ~s a 4-part form. <br />