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PfAMRTEE NAMEIADOttESSpweArlrMryN../Lo~wawt/D(QG.YwrJ <br />NAME <br />ADORES S <br />FACILrrv . ~;ntYO t~ I iVE <br />LOCATION =.E~ C~ ,` <br />~i_'~Y L- SA~!C'i_i': ~, `~P CIF U° <br />NATIONAL pOILUTANT dSCNMOE ELIMINATION SYSTEM /HPDES/ <br />DISCHARGE MONITORINO REPORT (D RI <br />PERMIT NUMBER dscHAnaE NtAteEn <br />MONITORING PERIOD <br />YEAR MO DAY Y A MO OAY <br />FROM TO ' <br />MINOR <br />( SUBR JC <br />F - FIJ~f <br />SJASH BA1 <br />Form Approw+d <br />OMB No 2040-0004 <br />NOTE: R~~d Inetructlorr b~1w~ compbtlnp thb form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, <br /> <br />EX FxeovENCr <br />OF SAMPLE <br /> ANALVSts TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />_ SAMPLE ~ ~ _ -- i ~ <br />~ <br />~ <br /> MEASUREMENT _~ ~ ~iJ ~ <br />~ ` <br />_. _, ,. PERMIT ~ . ~ :, ~ - , , - : ; ~. <br />1 ~ ... -, _, ' L , REQUIREMENT ~ X MC"•'~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> pEQUIREMENT <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICEA 1 c•nnf Y . pr^. ly o I.. In.l U+b aorYm<^t .nd WI .u.cnmenu .... <br /> <br />pRp.rM YndH T) airxlbn or wperH~o^ I^ .ctord\nce x•116 . f)i1Mn de4`ned <br />% /J/ 1, <br />~ / ,. ~ <br />' ~ <br />TELEPHONE <br />DATE <br />E / .r* <br />/ ~ ~ ~ to mYre 16.r aYltln•a pers^n^H properly i.ln...^a •..6r.Ir 16• I^r^r~n.llo^ <br />.Yb^rll.a. e..e ...,~ IwgYlr~ d tM pen^n e. pers^m r6^ Ytin.=e IAe:>>um, i <br />/.' r f;, ~ : <br />, ' / ~+ <br />J ' . / /~~' ~~ /~ <br />/ <br /> or thou pers^~e alr•cly .~po.olw. ter <br />.ln.n^ <br />Ine lnronruuew <br />I6e t^ronn <br />unn / <br />! <br />~~" ~ ~ 'f~`v!,~~', <br /> <br /> <br />C <br />Y <br />~ <br />' <br />I <br />~ <br />L <br />~ <br />r <br />i <br />, <br />. <br />wbmlued h <br />Ie Ihr bat of mr k^e.led <br />e vd beMrr <br />tr <br />e <br />ru <br />t. <br />.^d <br />w <br />kl <br />•~ ~~~ <br />,~ J L /n~ <br />~ ~/ <br />~ <br /> <br />? <br />~' - <br /> <br />- <br />om.</ <br />-~~ <br />"' ! <br />,l / <br />/ <br />~ <br />' <br />t <br />. <br />, <br />u <br />, ~ <br />n <br />. <br />ao <br />~p <br />t. <br />1 em ...r• au mrn .re d <br />'Jn<.^I a^.lue, rnr svnmNU^ <br />r.ls. InrormallrM <br /> <br />f10NATVRE OF MIMC1-AL EXECUTIVE <br />7 J 7 <br />- <br />< <br />TYPED OR PRINTED ~ <br />r <br />, <br />~ncludl^[ IM potwlblllir ^f n^. end tmprix~nrt+rn~ rnr krr.•.Inr .t^t.un^, OFFICER OR AUTHORIZED AOEKT CODE NUMBER YEAR MO DAY <br />COMMENTS AND t:Aru+nn 1lvn yr nn r •w~n ~ wn~ Irtlrrtrrtrnc• sn irr~cnmtenra ntrrter <br />'~~4HR FRfi>^IP EVEN'r~ I5 CL_Ari'1~D. IF L-L_AIM APPR(]V~C B'f WGICD; <br />_ - A. ~, r '?~N r_r 1_,;00. <br />EPA Form 3320-1 (Rev. 3/49) Previous edi6ans may be used. :~_~~;:' 7 i~ , '~T~iS IS 7 a-~ta_lOJitt PAGE QF <br />