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PfRMITTEE NAME/ADDRESSpw[r4s.rWryN../t«arwl/D~..wv/ <br />NAME <br />. , <br />ADDRESS ._~L.. t ..~ •..4./ <br />• LGi( 14jv <br />~.,AUL' Cn dl~ib <br />FACarrY SIDE ~~i'Th i, SC;;rF t'iINcS <br />L~j1'~ i'ALiSALc C.U X1516 <br />Form Approved. <br />NATIONAL POLLUTANT DISCHMQE ELIMINATION SYSTEM (rNPOES/ OMB No. 240-0004 <br />DISCHARGE MONITORING REPORT IOMRI <br />~-:'..d}1 t.~~ <br />PERMIT NUMBER OISCHMOE NUMDER _ c L 1 :: ? !•, i . <br />MONITORING PERIOD ~ - ` ' ` ~` ~ '~' ' `` `~ r. L ~' <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ~~~ ~ <br />NOTE: Reid Ift.ttvctioM betore.~olnpletiny this fofm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FIIfOUENCV SAMPLE <br /> <br />EX OF <br /> AN,tivsts TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~ u4ti' _~iSL'' "t`i;' <br />_ REQUIREMENT „ h r: *. <br />l ,. <br />- _ r .~ : : . SAMPLE . <br /> MEASUREMENT <br /> PERMIT - - ~ L / .. _ <br /> REQUIREMENT ~ ,.. ~ - . <br />_ SAMPLE _ <br /> MEASUREMENT <br /> PERMIT ~ '~ _ . ~. a . <br />_ .. REQUIREMENT _. ~ : " ~• ' <br />~_ .~ i <br />.. _... ~ .., _ ,. SAMPLE <br />. ~ <br />... MEASUREMENT <br />: <br />. PERMIT ..rL: - ~ r, :tip ~., ,;. ., .. ... ~I~ ~_'jA~ <br /> REQUIREMENT . , . <br /> ~ <br />: L. _ : ~ , <br /> SAMPLE <br />~ 4 Y :.. MEASUREMENT <br />' S 1 PERMIT { i ~, r l: ,. r° >. v a i _ L L :^ r ;_ <br /> REQUIREMENT <br />r.l1•. <br />,1 I"rd <br />• SAMPLE ~ , <br /> MEASUREMENT <br />~ _ PERMIT '-•• t1~.rCcl' _ `•.LY VI`:u.i <br /> REQUIREMENT i a 5 T C A X <br />. ,_ <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' """) " ` pe"") ° i... that fhb dorumenl end dl en.chmenb .ere TELEPHONE DATE <br />prep.red under m) dlr[ctlon or wpervblon In nccordent< ~Ilh . s)fl[m ddtned <br />-_ to more th.t qu.Mfled personnel properly tatMr end [. Ju.tr the Info[m.tlon <br />submitted. 6wA on m) Irpulry of lM person a persoru .ho rmnstt the trystem, <br />~ ~ - or Ihose prnoro dlrertl) raporolbk for t.theAnt the Informellon, the Infornrtlon <br />submitted b. to the best of m. -no~kEte end beMtf <br />trYt <br />.revr.le <br />end rom <br />Mle <br />, <br />, <br />, <br />p <br />. <br />I em ..... uet there er[ ,ttmtnrsmt prnetnv for submlltln <br />fete Imformuk,a <br />810NATVRE OF PRINCNAL EXECUTIVE <br />TYPED OR PRINTED t <br />, <br />tmrtudlnt the posdDWn or nM snd +mpAsnnmxmr for lnovlnt •toleuorn OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO OAY <br />COMMENTS AND EXF'L/1NA I tun t/r nn r vtvt.n t tuna flieniencrl M •rr~cnmmra n~i~i <br />. ,. ~Ii. cYcAT CCCUitS, SUbJEC7 7C EucLEh CF FFCCF <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. '1't11S IS 3 3-PBff fOFETI. PAGE <br />1 j... . . <br />