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PERMIT'fEE NAME/AODRESSR~rjarrNry N~..~l.et~naw l/D(QG.wq <br />NAME <br />ADDRESS <br />5 , .. _ X ,_; i i.i <br />E`ER ~T F345~ <br />FACILrrY - ER C~i!~YO"J M I IVE <br />~O(`,AT10N ~, C Q <br />,7IL} L. N;1~:.cR, f?USINE~S ~•1GR <br />NATION AI POILUTAHT DiSCHAROE EUMIMATION SYSTEM //NPOESI r <br />DISCHARGE MONITORING REPORT (OMRI <br />PERMIT NUMBER ascHnnoE NuMeEn • <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />ra;, paC;MG TO M <br />NU DISCHAP.G~ I~~! <br />NOTE: R~~d Irntrucdorw b~fwa eompbifnp thl~ form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, F>,EOUENCY <br />of SAMPLE <br /> EX ANKVSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' -` "" ' <br /> MEASUREMENT <br /> - <br /> PERMIT . ,.. _ ... <br />" <br /> REQUIREMENT ~ M I N I r,,, (.;,; <br />= ~ i ~'r <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ~ - ~ "•~ <br /> REQUIREMENT 30C:'A ~ -~ ~ . <br /> <br />' SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT • <br /> REQUIREMENT 1JA I L.'f M;<" `'_ :~d }- <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />' PERMIT <br />U <br />M <br />T ~ ~ ~ ~" <br />~3G;.-~ ' <br />t,~AI! Y MX <br /> IRE <br />EN <br />REQ <br /> <br /> SAMPLE ' <br /> MEASUREMENT <br /> <br />- ~ PERMIT ~ • <br /> REQUIREMENT '`'~ v -'`I ; <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ~ • <br /> REQUIREMENT _)A r~ .. F'r+:.' .'~ MX <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> _ <br /> PERMIT _ - <br /> REQUIREMENT ~'' - ~' ~~ ~" <br /> <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFlCER 1 nnttr u er pe n. 1~ o L. thtl tA H data mtnl •nd dl t11Khm Hllf were <br />TELEPHONE <br />DATE <br /> pnpt~d unetr m. dtrectton or wp. +.yon m srcord.nn +nn . srt+em detxnta <br /> <br />' <br />~ to more thtt gastlfted personnel progeA( ~.Iber Ind erNu.lr Ibt Infarmalbn <br />tabmllted. based on m~ Inqulr~ of IAt ptrwn a persorn .bo IruntRt Ilse r.sum ~' <br />I <br />~ -_ . <br />or Ihost persero dlrKllr resporedbk for ~atherirK 111t Information, Iht Inforen.llon i ~ ~'~ ~ ~ -~ - " ' <br />~ <br />~ ~ <br />~ <br />. _ wbmiutd b. to the bets of m. know4d~e ^nd bttlef, Trot, teeu rtlr, Ind rompkle. •.~ <br />-.. ~ ~ - <br /> 1 .m t..n thtt inert ne si <br />nlllnnt <br />entltkt for <br />bmlltin <br />b6t Inf <br />+ <br />tl <br />n EIONATURE OF M1INCIPAI EXECUTIVE , <br />TYPED OR PRUVTED ~ <br />p <br />w <br />~ <br />or <br />n. <br />o <br />, <br />IneludlnL IM passiblYt~ of fine Ind Impr4sonrnenl for knoaln~ eidtUons. OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IR~fs~anca all atfachmant~ haral <br />! EAL~! i= SnLID~ t_MT AP°L'I?-~•, cUR C=~iOYR, ;?4Hf? PREC: . <br />EPA Form 3320-1 (Rev 399) Previous editions may be used This is a 4-part form. PAGE OF <br />