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PERMITIEE NAME/ADDRESSpwr~ttYi^cwryN.y~t,.e•tf°„1/D(OF+nU <br />NAME <br />ADDRESS • - .y <br />..J1N„ ~+vK"!n Z1 ::Qulr' ;~1t~~S <br />t~JX iu,iU <br />FACILITY -,~~~ CG dl~Lt <br />LocATION •~S1uE h'JEtTr. G ~c;'J1'H i;1t~t,S <br />. PALI~AC~ CC bI~ZE <br />' ,.u t t t t• ~- t <br />NATIONAL POLLUTANT DISCNMOE ELIMINATION SY4Tp.1 rrNPDESI <br />DISCHARGE MONITORING REPORT IDMR/ <br />PERMIT NUMBER ascl+MOE NuMeEn <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br /> <br />Form Approved <br />OMB No 2040-0004 <br /> - NOTE: R~~d Irtitnicdor» b~lo r~ ~ plotlny thb form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. Fr1EOUENCr <br />of <br />SAMPLE <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX MAtrsfs TYPE <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />1 <br />REQUIREMENT ~' ~ ` f t <br />r aJ~., h <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br /> <br />REQUIREMENT <br /> <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br /> <br />REQUIREMENT <br /> <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br /> <br />REOUIREMENT <br /> <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br /> <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br /> <br />REQUIREMENT <br /> <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br /> <br />REOUIREMENT <br />NAMElTTTLE PRINCIPAL EXECUTIVE OFFICER t "^'tr ° " p`"' tr ° I^~ th^t ub document ^ne ^u ^tt^chrnenb sere <br /> <br />_ - _ prep^red under mf directbn or wper.hlon In ttccord^nn rllh ..rstem dd[ned <br />to tt.sure u.t a..nftw personnel vtw-r+r nth« ^rtd ntJu.te the inrot•m^tbn TELEPHONE DATE <br />• , - , <br />~ wbmltteel. ltsud on mr In<tulry a! the person or persom who m^n^te the fretem, <br />or Ihtwe ptrwro dlrectlr reepondbk for ^therln the Inrorm^11 <br />[ t on <br />the Inform^llo <br /> , <br />n <br />wbmilted b. to the bet of me tnow4dte ^nd beNef <br />trw <br />tlecv nl <br />^ <br />d <br /> , <br />, <br />e, <br />n <br />eompkle- <br />I ^tn ..^re u^t were ^re td[n115c^nt pen^Itle ror wb <br />lttl <br />r <br /> <br />TYPED OR PRINTED m <br />n[ <br />^bte mrorm^tlon, <br />Inc4udlnt the potdDllllr or floe ^nd Impryontnent f <br />r k JiIONATLRF OF IRINCIIAL EXECUTIVE ~ <br />` '. ~ <br /> o <br />nowln[ eld^Uotn OFFICER OR AUTHORIZED A A <br />COMMENTS AND EXPLANATION OF ANY VIOL ATIONS (Rd~r~nc~ a/J s+tttrchm~nta h~r~l AGENT NUMBER <br />CODE YEAR MO DAY <br />' • _. ~ M }{i ~1 i V Y ~1 P L4fi ~ r n ECir• • a=. {I L.'~ i ~.Lr I; r ~` ,. . ~ ~ - i . <br />EPA Form 3320-1 jRev 3,'99) Previous editicns maybe used This IS 8 $-P8t( IOrEI1. PAGE OF <br />