|
PERMITTEE NAME/AODRESSpnaYJri«~bgN../L«.rro..l/D(Q6..,.q
<br />NAME
<br />ADDRESS , 1 ~ .. ., . ~ •, J ~ L :. .. 1 .l ._,
<br />• $OX 14 3U
<br />. ~dD>: CC biSLU
<br />FACILITY ' J 1 v L iJ (J )t ~ H t, :- C iJ i t1 C• 1 :~ ~: ~i
<br />L~T~ t~dLL~nUh CC tslbib
<br />Form Approvt:d
<br />NA71pNK COILUTANT OtSCMAAOE RIMINATIOnI SV STEM (NPOES/ OMB No. 2040-0004
<br />DISCHARGE MONITORING REPORT (OMR/
<br />,. Boa L^)
<br />PERMIT NUMBER asc~~aaE NuMaea _ ~ ` I, . ~ » E
<br />MONITORING PERIOD - ' " 1 ti ~ G'
<br />YEAR MO DAY YEAR MO DAY -
<br />FROM TO
<br />NOTE: Read Inattvctiorw b~ta• r_ompl~tlnp thla }am.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FnEavewcr SAMPLE
<br /> of
<br /> EX ~N,tirps TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />_ SAMPLE ~
<br /> MEASUREMENT
<br /> PERMIT ...... "I
<br />
<br />~
<br />- _. - . - ..
<br />._
<br />r.
<br />~ _ ..
<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 /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br />PERMIT
<br />REQUIREMENT
<br />NAME/TITIE PRINCIPAL EXECUTIVE OFFICER ' """~ ° `a", t/ o b. tn,t tAb document •nd ,11 ut,rnmenb .ere --
<br />TELEPHONE
<br />DATE
<br />prep,red ender m~ dlrtrtton or wyrrrhlon In ,ccord,nct rlth , s]stem dal[ned
<br />-. la aware th,t qu,Mfkd penonnei PropeA/ L,IMr ,nd eryu.le the Inform,tlon
<br />talmltted. aced on m~ Inqulr) of IM perwn or penwn .Ao m,n,Re tM .rsum,
<br />or Iho,e penoru dlrcrUr respordtrk for ~,theAnj the inrorm,tlow, the Inrerm,tlen - - , ~~ ~ ~
<br />wpmllted b
<br />to Ine Hell of m
<br />knowled
<br />e ,nd b
<br />ar!
<br />trve
<br />,
<br />l
<br />d
<br />' /
<br />/
<br />~
<br />g
<br />.
<br />e
<br />,
<br />,
<br />cevtl
<br />e, ^n
<br />complete.
<br />1 ^m,w,re G,t tnere,re Opdfk.m pen,ltla for wbmltUn~ h6e Inrorm,tlon
<br />NONATURE Of Nf11NCt/Al EXECUTIVE ~
<br />TYPED OR PRINTED ,
<br />Inriudin( the Vowlslu4 ornne,nd Imprt,onrnent roc kno+ln~ rid,uorn OFFICER OA AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />GVMMCr'11 J AMU CIar~Ann ~ iv•~ v n... ......-...vow In.•.•~nc~ r• ~u.crnn.nta n~rq
<br />_ _ ~ , suttfi f'!'ECIP. tYtNT CCCCr:~, SU~~JECT TG ECbCty CF ~nCCF
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~'hIS 1S 8 4-part 10~1T1.
<br />.,36. ... .-_
<br />
|