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1'ERMITTEE NAME/ADDRESS p•d.v F«•Wry N~tt/Lor•r+on (/OrQGrewr) <br />NAME <br />ADORESS <br />~r BUJ, ..t i V <br />ER UT 8 52 <br />fACILrTY 'ER CAi~:YO'~t i"ITrtiF <br />LOCATION '~ ` ~~ ° ~~ <br />~~ID B. Pt'~.LER, BL;Sil~~S~ r1GR <br />Form Approved <br />NATIONAL pOLLVTANT DISCHARGE ELIMINATION SYSTEM //NPOESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (OMRI <br />r• :~ <br />PERMIT NUMBER ascHAnoE NuMeEn ~ I NAL_ C'R ~ <br />~:; ('R DSCFiG TO ti~~NG'Eri '-R <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY }~ <br />FROM TO <br />NOTE: R~~d Ir,Atructitxlr b~itx~ eompl~ifnp thl• form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX EREOUENC~ <br />of SAMPLE <br /> <br />TYPE <br /> ~NALrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ` <br /> MEASUREMENT <br /> PERMIT .., - ,- _, <br /> REQUIREMENT ~ i`?AX7.f'P <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. .. ., - <br />" i" <br />X <br />~ <br />• REQUIREMENT ;t7DF. r i <br />'-. ti <br /> SAMPLE ~ ~• <br /> MEASUREMENT <br /> PERMIT ,. , . ,. <br /> REQUIREMENT .:(aL? -~ + rya I!_Y :•.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. , ... ., , .- <br /> REQUIREMENT <br />' SAMPLE <br />' MEASUREMENT <br /> ..PERMIT - I ,. <br /> REQUIREMENT ~~'.:~A rVG DAILY t?' ; <br /> SAMPLE <br /> MEASUREMENT <br />.- <br /> PERMIT ~ . ,..... . - <br /> REQUIREMENT . , ,c~A _ ~~ i LY ;`i X <br /> <br /> SAMPLE `~ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ?A ~ . • ~ " <br /> <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER 'te^'q ° er pers. t, o I•. in^i u <br />^red undrr mt tH reelbn or w <br />rt t+d«vment ^nd •n ^u^chm <br />er.faon In tneord^txe wtth ent+wtre <br />^ s]atem dd=rwd TELEPHONE DATE <br />. - _~ :_ _ <br />~- L~ -~ p <br />p <br />p <br />to tenure Ih^i qu^Nnee personnel properlJ j^IAer ^nd er ^lu^te the Inbrwrlbn <br />sobmltted. et..e en mT InqulrT or tlw person or perwro who nun^Rt tht tvttem. ~~ <br />/6 ~ "S <br />~ ~~~ <br /> l <br />r G <br />^ <br />~` ----~ ? ' <br /> or (nose persem d <br />recllT responabk for (^tAerln~ the In <br />orm^Ilen, the Inrorm^Uon • <br />~ <br />. _ <br />; <br />I <br />~ <br />~ <br /> whmltted b. to tht Ant of me knowkd~e ^nd Dted. trot, ^cconte. •nd mmpkle. r <br />b10NATVRE Of MINCIPAI EXECUTIVE f -~% L <br />'" ' <br />~ ~ _. <br />, ~~ i .~ ~, <br /> I ^m ^w^n u^t then ^n p~Nnunt pen^lna for ^uAmltnnj bl+e tnform^tbn, <br />TYPED OR PRINTED itwiueln~ the posaAtetr or not ^ne ImprSsonrnent roe Ano.ln~ .lol^tbrei OFFICER OR AUTHORIZED AOEMT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION Vr An r vw~A l tuna rrr•nrtrrrctr sn •rr~cnmmra n~r~r <br />I~~ _ VERAC <br />. , i2Ef~SE <br />EPA Form 3320-1 (Rev 3199) Previous editions maybe used <br />;HEST ML7NTHL AVG. DURING PEF:iOD REPr1R <br />This is a 3-par: (orln pnGE Of <br /> <br />