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PERMITTEE NAME/ADDRESS (InaYJri~eY,ryNwa~Lor.nae IJD~irenr)
<br />NAME C~J'~I3f:lk! I'JIEVIIVG, LLC
<br />ADDRESS ~-~A~~~1RE`~E ~:.~E'S, ~t Iw~Eh ~Rlh MIE`~!
<br />aQE~1ERSE`?~ CEa 5~.4;3~
<br />FACILITY ~iAEVD01",h~ CREW, tit ELE~t C~2K MIEVES
<br />EocATION~~.OE"EERSE•'f CE~3 ~I.~#•~~#
<br />ATTEV: JAEMES T. uE~C?~EE,, EX>rC 'v'. P.
<br />NATIONAL POILVTANT aSCHAROE ELIMINATION SYSTEM /NPDES/
<br />DISCHARGE MONITORING REPORT IDMRI
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<br />PERMIT NUMBER ascHAROE Nt1MaER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM *i~ a~~ aI TO t~Ji~ ~O~z '~ ~.
<br />Form Approved.
<br />OMB No. 2040-0004F
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<br />NOTE: R~~d Imtructions b~fw~ c mpbtin9 this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO,
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<br /> E ''i1°~Y~s TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' «rtttr u er pen, t~ o Lw Iha IhN doeurnenl .nd .u .uachmenb were
<br />prepued under my dlrertlon or auperrglon In .eeordante with . system desl(ned TELEPHON E DATE
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<br />J A ~y~ ~ to assure that qu.NOed perwnn[I properly plher.nd erdu.le the Inronutlon
<br />rtbmlued. eaeea on my Inquiry at the perwn or pertntu who m.n,(e the,
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<br />submitted b. to the bnt or m7 knowkd(e end beNef, tne, .eerrnte, .nd mmplele. 70 ~ ~ J lG Z d g ~~•' a8
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<br />~ 11m .w.R th.t Ih[R .R si(nlfitlnt pemitlq ror Albmittln( htse InrOrrrutlon 81ONATURE OF PRINCIPAL EXECUTIVE
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<br />Ilne.nd Imprhonment for knowln( rloleUons. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS ~RItI/InC1 s// •ttachmints h~r~)
<br />TSS °< TSTAL ~I RDEV LIMITS WILL IIE WAIVED, REVD SE"E"TLEA]3L,E SQL I I}S Lh9T AI'E'L I ED FQR ~~ =1 DYE?, ~•~?•1-~Ei E'F~E+: !: P EVENT;
<br />SETTLEF1a3LE SE7L I Ds LIMIT M~,Y L E WA I VFD FCIR • i aYR, w4HR EVEIV'F-SEE I . ~. 1. , E'E' ~°-~',, REVD I . A. ~'., !'. 5 ~'SR RGMNTS.
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. ~~ ~,~, i ~ a~~$~Q;=~~[-~,(~ryp, PAGE ~OF
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