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PERMITTEE NAME/ADDRESS pt.drf.f.crhryNrw/L«.nw IfD~ir.entJ NATION AI pOILUTANT DISCHARGE ELIMINATION SYSTEM (NPOESI <br />NAME DISCHARGE MONITORING REPORT /OMRJ <br />ADDRESS _. <br />• bOX lu.J. PERMIT NUMBER ascHAROE NUMeE11 <br />•- • ~ ~ ~" ~ MONITORING PERIOD <br />FACILITY j I D t N L r ::: ,. _~ I, ,, i :. :. 1 !. : _ <br />YEAR MO OAY YEAR MO DAY <br />LOCATION L' A i I S P. L 4 ;; (: c . _ FROM TO - <br />.. ...i~1h i.. Kiuiit6, +. k'. <br />(_U5H LI.j <br />F - fi:+ri <br />FC~::C 5 TL CChL CFs"1•n <br />Form Approvetl <br />MME; No 2040.OOCa <br />NOTE: Rssd InstrutKlaw D~fo~~compl~tlnp this iwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, fREOUENCY SAMPLE <br /> of <br />Y <br /> EX ANA~rsts T <br />PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE i <br /> MEASUREMENT <br />. .. PERMIT _ L~C' nT l ~ : ~ I 1 :~ .. <br />. ~•~ ., a _ t REQUIREMENT C :, . i M r. X - . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENTC <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 rcrttl) . er pen^ 1) 0 1.. lhel IhN don.menl •nd ell •IlKhmentf wtrt <br />TELEPHONE <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />prcpend under m) directbn er super.tslon In a~ord.nrc with . stem ad~ned <br />_ to asur~ IhN ttu.nned prrsonnel pmptrtl t.ther .nd er.lu.tr IM Inform.llon <br />wtbmltted. 6nrd on m) Inr•ulry of the person a persoeu who muu~e the .)stem, ~. <br /> <br />' or those persoro directly reponslhk for p1Aerlnf the InformaUOw, IAe Informulbn ~ ~.. ~ ~ ~ `. •, ~ '~-. r <br />~ <br />: <br /> <br />. suhmltted k, to the het of m) Lnowled~e •M beMef. True. .ecunte. snd compkle. ~ <br />I •m •werc UH IAerc src fl,nlrlcsnt <br />rndtle ror wbmlttln <br />810NATUBE Of pAINCfPAI EXECIlTiHE <br />filer Informatbn , <br />~' ' .. ~ <br />' <br />• <br />TYPED OR PRINTED p <br />~ <br />, <br />mdudln~ the posdcnu) ,r nne .ra ~mpnsonment rnr -nowlnE .Inl.uor,i OfFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rsfsrsnc• •N •ttschm~nts hsrsl <br />. _ _ . . . ~4ii!( rBECIP. <br />:,ECT IC rl.cCf:at C F FrCCI <br />A <br />EPA Form 3320-t (Rev. 3'99) Previous edfions maybe used. This 15 8 4-Pell IOrnI. <br />