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Form Approved. 8 <br />PERMIITEE NAME/ADDRESS peeY/rieWryN.w/Goeatoh 1/D(Q6ranq <br />NAME C7}SI~~W h'IICtIC•!G, LE_C <br />ADDRESS *~A"+IIiC3t{C~i i:RK ~t ~3...!-'t i,f~t; t`9I~IE~ <br />P. CI. ~3LX r~:~5 <br />sr~M~R;~~°r ca ~~~~~. <br />FACILITY ~~Ai~i~©~{~ ~~(~ ~t ~:.L{~ :;1~~~ C'fICdLS <br />IOCATiON~,-"'y[}~'-~~I:iSET i~•G ~~.=i-~~ <br />ATTC.I: iJAMES T. ~.C]QPIwR, EXEC V. F. <br />NATIONAL VOILUTANT DISCHARGE ELIMINATION SYSTEM //NPOESI OMB No. 2040-0004 t <br />DISCHARGE MONITORING REPORT ~DA4R/ M I hJDR <br />il(~ODi}~7I3~ irli7'g A i St)I3~t I"tH } ~ <br />PERMIT NUMBER DISCNARGE NUMBER ~` - F T SAL- i~E.1N 7 5 <br />MONITORING PERIOD SUPS' RUNCIt~1- T~ ~ F~~' ~Uh~tIS RI~';~' <br />YEAR MO DAY. YEAR MO DAY <br />FROM TO •,. ~ ,~ -~-~°# i ~t~i I.) I ~~.~l-~t~f~: i~~' ! ~C , t #~•aE ', <br />NOTE: Rud Imtrucdora bsfors complstinq this form. <br />PARAMETER 4UANTITY OR LOADING QUALITY OR CONCENTRATION N0, <br /> <br />EX FREOUENCV <br />OF SAMPLE <br /> <br />PE <br /> ANALrsIS TY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />ClZL. ACID Gkl<'ASF SAMPLE ##-•~##~• +, .~} ###### #~z•it•### if##### <br />~~':i aUA~.. MEASUREMENT <br />t~1,~4i'1~_f ~, L~ ('} ;PERMIT #####iF R,I^P~RT ~~=~. ###### ##-~~-## ###### ~•#~r NC)=/ iSUA <br />Et=~F~~L~;S~C1T CP~lSS ~`ALU R~QU{pEME1VT <br />_ _ ItVST MAX CdCiwij •~##~~ C9pNT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> '`PERMIT <br /> EtE(lUIREMENT> <br />.................... .. ..... <br />........................ . <br />.... ................. <br /> SAMPLE <br /> MEASUREMENT <br /> >PERMIT <br /> REQUIREMENT <br />,:::.: _ _ <br /> SAMPLE <br /> MEASUREMENT <br /> ::'PERMIT <br /> REQUIREMENT <br />:::.:............... . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '' <br /> REQUIREMENT <br />_.... <br /> SAMPLE <br /> MEASUREMENT <br /> .'.':PERMIT <br /> REQUIREMENT <br />NCIPAL EXECUTNE OFFICER t """y ° e. ~", ty a Isw thtl IhN document snd HI etfscstmeMS were TELEPHON E DATE <br />NAME/TITLE PRI prepared under my direetlon or supervMon In sernrdsnee with • system desl`ned <br /> to Insure that qusHfitd personnel properly ether and e~duste the Informrtllon <br />~ <br />//~~ <br />J G t""f J ~ , ~Od sabmltted. heed on m7 Irpulry of the person or pertoe who nuns`e the system, ~ <br />^- ~ f <br />- <br />, or !base penoro directly respoelbk for plherlrtt the Inforrrullon, the Informstlon - <br />~ <br />xy(~ y~1 <br />~y1 t <br />j <br />~7 ~ Q <br />(°C_ , ~t r S f ~`f~ V~ 1 <br />V submllted h, to the bnt of my knowkdFc snd betlef, true, sccurste, end mmpkte <br />ism rware IhN (here ve sl <br />nlllunt <br />ensitla f <br />ubmlttln <br />r <br />fate Inf <br />r <br />atl <br />SIGNATURE OF I'RINpPAI EXECUTIVE ~ <br />/ ~ <br />~ <br />Z <br />/ / ^J L ~ Q ¢ !J <br /> ~ <br />p <br />o <br />~ <br />o <br />s <br />m <br />on, <br />TYPED OR PRINTED IndudlnE the ponlDility of ene snd Impdaonment for knowlnp •Idstlou OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS ANO EXPLANATION yr nr+lr vwln l lens Iffasrmcs a/i ~rracnmsnrs nsrs) <br />TSB' ~, TC'~l"AL I tiOCd L I ht I TS WILL 13 E War I V~L}, ACdL~ St^T'Ti_~:AL"-"- L~:: SCIi.... I DS i._I''!T APPL I ~D Fi~R •~:=1 CIY R, ~~kH? PR ~~' I P EVEC~iT; <br />SE~"'C1...u.A~i_.)r ~!7LIT}S LICIIT C'fAY 13F WAIG't=D F+:IR >IOYK, 2~t-ER EVECdT-SSE I. A. :L, PF 4-5, AC#)~ I. t't. ~: F~. S t:"~h RQt'ICdTS. <br />EPA Form 3320-1 (Rev. 3199) Previous editions maybe used. ,... T~5,1.4-Uat't_~Otrp, ,.., r^ ~ .`+ <br />