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PERMITTEE NAME/ADDRESS pndrfrF.rW N~./L««rew Form Approvl3d <br />4 UD(O~re»rl NATIONAL POLLUTANT dSCNAAOE ELIMINATION sY3TEM NPDES/ OMB No. 2040.0004 <br />NAME DISCHARGE MONITORING REPORT IO~R/ <br />ADDRESS . <br />..) . J <br />• r3 J ~ i PERMIT NUMBER dscNAAaE r+urrteEll _ F j ti ~ i lti t ,J <br />FACIIfTY `SAD " MONITORING PERIOD J ~~ 'I C C C L C b A L 1, n 1 Y ~. r <br />LOCATION J 1 J t '' ` ' - ' ' ' ~ - YEAR MO DAY YEAR MO DAY <br />~ A L I J A J t (;;~ ~ j~. FROM TO - . ~/ <br /> Hurt: n~~u ItNTR1Ct1011~ b~fO 1b pom pNtttlo this tot R1. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, mE° <br />u <br />ENCr SAMPLE <br /> o <br />F <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAtr~s TYPE <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~ c ~ :~ : 'c A S i <br />,, <br />SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT , <br />~ ~ <br />•, . <br />1 '. <br />_ ' / <br />, <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT n <br />a ;; <br /> <br />REOUIREMENT , <br />,.• . <br />.. <br />/i :. !• 1. ~ '? <br />~ ;; / <br />: n A C <br /> r ~ v <br /> SAMPLE <br /> MEASUREMENT ~ . <br /> PERMIT <br />_ REQUIREMENT '''' ~ - ~ ~ ~'- ~ , , <br /> <br /> SAMPLE <br />MEASUREMENT ` '. <br /> PERMIT <br /> <br />RE <br />E 3. F ~, <br />c ` <br /> QUIR <br />MENT •. <br />~ . ~ . i ' .., <br /> v <br /> SAMPLE <br />M <br />' ''~ '~ <br /> EASUREMENT <br /> PERMIT •~ <br />i ~ ' v <br />. ~; `i REQUIREMENT' ~. r (; ;. <br />.. . ~_ r ~_ ', L '~ ~• .c-. 'f A i <br /> <br />1, : ,. 4 <br />_. _ , r - <br />SAMPLE <br />- <br /> <br />_ Y ~ . . MEASUREMENT t . <br /> PERMIT <br />_ <br />Y ~ <br />F(.: r}' <br />E~F1 <br />RE <br />' <br />. <br />. <br />QUIREMENT ~ ~ y <br />(, t ,; <br />1 nnrl) • r. pen. I] 0 1.. Ih.t uh document .nd .11 .tl•rnmrnU were ~ ~ j' ~ ~ v <br />NAME/T1TlE PRINCIPAL EXECUTIVE OFFICER <br />pnP•ree under m dlreruon or •u <br />~ Pmy»^In.ccord.nte»un•.r,lr,nat~tnta TELEPHONE <br />- DATE <br />- - <br />In aeon Ih•I au.n lted perwnnel Properf~ (.Iher .nd erNuelr the Inrernqu <br />n <br />. r-. o <br />w,Dmllled. 6•wd en mr InqulrT of the ~r>,on a perst»p .ho m•ns <br />th <br /> <br />' te <br />t Irtlem, <br />or Ihose prrsom dlrern~ refPon9Dk for plherl rlt the Inrorm•Ilew, the Infonn•Ibn <br />- <br /> wAmllltd 1•. to the btll of m~ krww4dtt ^nd heNef <br />Irvt <br />.[tunic <br />^nd <br /> . <br />, <br />, <br />rntnPlelt. <br />I •m ^.•.. u <br />1 Is <br />~ <br /> <br />TYPED OR PRINTED • <br />ere .n dt„inc.nt pcnslnes roc wrhmltnnt nett mronn.non, <br />Inrludlnt the porwul <br />or nn <br />. <br />d I iIONATURE Of IRINCIrAI EXECUTIVE <br />, ~~ <br /> ~ <br />e <br />n <br />rrrprt•onmrnl roc knowlnt .Id^Irau OFFICER OR AVTHORI2ED A A <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL <br />ATIONS /R~/~r~nc• dl •tt~chm~nfa h~r~/ AGENT NUMEiER <br />CODE YEAR MO DAY <br />. ..... .. <br />EPA Form 3320-1 (Reo 3'991 Previous editions maybe used Ttlis is a 4-part form. PAGE OF <br />