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Form Approved <br />pERMITTEE NAME/ADORESS (~r.aM4 FarWry Na../tvrNCar I/DlQwenry HATION,4 POIWTANT DISCHMOE Ei1MINATION SYSTEM /NPDfSI ONIl3 NO ?040-104 <br />NAME DISCHARGE MONITORING REPORT IOMRJ ~~= <br />ADDRESS "'' _1!.• i`. j :Uii~l :_~1n' i <br />;5, 5flK 3i0 - FINAL GRrLD <br />~'}~ •_I PERMIT NUMBER ascrtAnaE r+vMeca <br />~EST.hiG FOR ~-~~-'~= <br />FACILITY : SFi CP.i`JYQN M I I ; MONITORING PERIOD _ <br />LOGTION Y AR MO DAY YE R M DAY - • - VJ <br />I I7 1~ . WI I LL ER , L1. ~ Z ,~lr :-, r . , ~-? FROM TO ,~. <br />NOTE: R~~d Ir»truction~ b~for~ compbtirl0 this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FnEOUEncr SAMPLE <br /> of <br /> EX ANAl~stg TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br />• MEASUREMENT <br /> <br /> - <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 /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE ' <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TfTLE PRINCIPAL EXECUTIVE OFFICER ' """r ° er pena ry o ta. mat Urb documem arw •u attachnrnU .e.e <br />TELEPHONE <br />DATE <br />prepared unMr m~ dlrxllon a fuper.tflon In accordance rtth • r7stem ddtned <br />_ <br /> <br />._~ , ._-_ to aswre that qualltled per»nnel pr^prr1~ tslher and to ahrate IM Inlonnalbn <br /> <br />wtbmllled. lased on m~ inquiry or IM person a persona .ho mana <br />e the f <br />etet^ <br /> <br />~~ ~ <br />-.- <br />i• <br />/ " <br />_ ~ t <br />y <br />, ~ <br />~ ~. <br />7 <br /> <br /> <br />- or Ihtee penom dlractlr nnpond ble !or talher/nt the Inforntallon, the Inlsrmatlen <br /> <br />submllted b>, to the best of m7 krtow4dte and Dalrf <br />true <br />ateurale <br />arW <br />kt ~ ~ ~.~-.-- - _; ~ <br /> <br />•- <br />i; / <br />~ <br />; '- / ;/ <br /> <br />~ `ci <br /> <br />- <br />_ <br />' - , <br />, <br />, <br />cotnp <br />e. <br />I .T..... ua tnrre.re sltrdnom pen.tnea ror tnrbmlmnt r.-ae tnr^r,~.o.n a NATURE OF MIINCIPAL EXECtlT1VE . ~. -- - ,~ ~ .-' <br />TYPED OR PRINTED . <br />tne+ndtnt the poadbtlq o! nnr .nd irrtprtsonmrnt ror lnn.int .tol.tlote. OFFICER oR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />CUMMtN 15 ANU [/~r~.nnn t tun yr nr.. a rv~n r tvr~a rn~,~rmw sn itr~cnmmra n~i~/ <br />~~JLTS OF LF fHAL I TY DE^n I VA T I0~3S AS " % E1`'F ECT" . GROWTH ANO <br />, - - - <br />• _~.: <br />EPA Form 33?~-' tRec 3'99' Previous editro~s r^ay be used This is a -i-part form PAGE OF <br />