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rERMITTEE NAME/A~DRE55 (Iwe>VbF^rWryNw/Leru/on (JD{~G+rnr) <br />NAME <br />ADDRESS <br />FA aLtrY P1 I ! J E <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION 5Y47EM NPOES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUM6ER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />_.~.. ~.. .. ,..=~7 <br />~MB Ilc ~C4';-OOD4 <br />NOTE: R~~d ImtnictloTa b~tlx~ compl~tl~y this Iwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, fREO <br />UFNCV SAMPLE <br /> EX O <br /> A~+Alrss TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ <br />~ ' <br />~ <br />~ <br /> MEASUREMENT <br />~ _ <br /> PERMIT ~t : ibH -~~ = .< , . HLf ( - u-_ !A'iE ~: ~i-;~;f;;-~ <br /> REQUIREMENT - I`SN Vi;L _ L 'r' <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 /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMEIT <br />1 WWII) Y <r prn^ !~ O 1^w lhat IhM dxumtM ^nd ^II ^II^fh rtRnLt wrrc <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />DATE <br />R •red Yndfr T~ EtR<IIOn Of w <br />D D pmhlon fn ^<cord^n<e wllh ^ fT^lem deflEned <br />to egvrt IhH qu^IIfMd prrwnnH proyerl~ E^IMr ^nd r.^Iu^Ir IM Inform^Ilon ~ J - <br />s ~~ ~~ V ~-~ ~ _ ^Yemlllyd. 6>.ed nn mT ~ngYlr) of ue p^r^on r prr^oro wAO m^n^Re lM ^rflMn, ~ ~ P ~ ~ --- ~' <br />~ t <br />,- <br />or 1110fr prr^on^ dlrrellr mponflbk for ~^III<A n~ Ihr InfOrm^Ilon. the Inform^Ibn -- '~ ~/ ~~" .- <br />• .. ;-. wbMlltd If, 10 Ihr ee^t nr rtp know4d~r •nd MN<r. Irur, ^rRlnle. •nd erxllpkle. --~. ~~ .Y,' ~,/., <br />I <br />~~ <br />~ r /~ <br />~ - ~) <br />~~~ <br />j <br />.' <br />I ^m •w^n U^I Ihrre •re tJ~nlftt^M pen^Itlrf for n.emluln~ M1Frt Infornutlon <br />fl ATURE OF MtNC~AI f XICI"FVF <br /> , <br />I <br />l <br />dl <br />r ' A <br />TYPED OR PRINTED nc <br />Y <br />n~ !n< p.,..f bllilr n <br />flnr ^nd Imprt^onmrnl fa knowln~ •Id^Uort>L OFFFC <br />fA OR A UTNOAIZE r, .... ~ . <br />l <br />.-;~E HUMEfER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXF'LnnA t lun yr ~n T vfv~n 1 Iona Ir+~r~~MC1 en •rr~cnm~nra nrr~l <br />EPA Form 3320-1 {Rev 3~~) devious edrbons may be used t~3=I Th15 lS a 1-Q~( fOrn1 <br />J <br />