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PERMITTEE.NAMEJADi)AESS p.nt.r. FaikryXwalL^r^rloe l/D(Qiwq. <br />NAME <br />ADDRESS <br />F,.._ l_i1 .., <br />:~~~>/rc>`~ co <br />FACILITY `~ -OW~Y O P'IZ NE <br />LOCATION ~ L;_KEf~ GO <br />-:~L~.Y D. 5r+idt~~~S: eJP DF <br />NATIONAL pOIIUTANT Ol5CMM6E EUMINATION 4`I3TEM (NPDES) <br />DISCHARGE MONITORIN4 REPORT (O RI <br />PERMIT NUMBER ascNMOE NuMeE>~ <br />MONITORING PERIOD <br />YEAR MO DAY YE ~ D Y. <br />FROM TO <br />,:~~. <br />Form Approv!d. <br />(`l l N Cl i't OM9 No 2040-0004 <br />~ Sl.1IiR •.{C. ) <br />F - r I +~lAL <br />cosSafK n ~cr~n ~ Q w i Lsr/:~~ ~ ft <br />-- ~ <br />NOTE: Rs•d klstructlotw bstors cpmplstFnp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. <br />EX F>,EUUENCv <br />OF <br />SAMPLE <br />TYPE <br /> ANUrsts <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE <br />- MAXIMUM UNITS <br />.. <br />/ SAMPLE ~ ' <br />~ 'I`1,~ 'j <br />J <br />'~'j~l-- MEASUREMENT .. <br /> <br />- - <br />- <br />:~-~ <br />, <br />._~ ~~ <br />,..,- ~` ~.: I~^f,; ~. ..~.: ,: :. i~ <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 />--- 1 <br /> REQUIREMENT <br />~ <br />j <br />-- <br />1 <br />-- <br /> <br />- <br /> SAMPLE ~ - <br />' <br /> MEASUREMENT I <br /> PERMIT - - - - - -- <br /> REQUIREMENT <br /> <br />AME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 mill) Y prn/ I) O ^~ Ih^t Nh davlnenl ^nd aN ^IlKhrnenla were <br />~ <br />TELEPHONE <br />DATE <br />N pnp^red roger m~ dlrecllon or supet+l>ton In ^ccerd^rKe rilh ^ a~ttea dd~ned , <br />~ <br />1 / <br />/ to inure Ih^t ~u^Mfled personnel preperl~ ~^Ihtr ^nd ee^lu^Ir 1M Inrnrin^Ibn <br />^ <br />llled <br />S <br />ad <br />a I <br />In <br />ul <br />or th <br />aw <br />6 <br />h _ - / i <br />~ <br />r <br />' <br />/.. t ~ <br />. p <br />^ <br />m <br />. <br />^^ <br />e <br />nd <br />ry <br />e p <br />n a penore . <br />e a^n^~e the >,rsiem. <br />w tlio^e penal dlreetl~ reapadElr for =^theAn~ the Inrornullon, the Inrorm^Ilen ~. <br />/ <br />. <br />, <br />V~'' ~ ~ ~.-~ i <br />7/~ /y~~./_ /~~J <br />/')~i- ~, / ~ l <br />) 1 ' - _ ~ <br />1 . ; / <br />'` `/`'~F ~'' ~' ~ wlmllled b. b the Seal er m~ tnedad~e ^nd 4eMri. lrre. ^ccunle. ^nd nompkle <br />nlrwnt <br />.^n u^1 thrre ^rs al <br />en^1He^ hx <br />emltnn <br />t ^~ <br />r <br />he l <br />r <br />ebn <br />aIONATLlRE Of -RINClrAI EXEL't)TtVE ~ <br />(VJ CX) `~/ / j/O Y <br />TYPED ~ ~~~ F <br />p <br />^ <br />w <br />~ <br />^ <br />n <br />orng <br />, <br />lnrwalnt the podhldry ornne .l.a llnprhonmrnt ror Lno,ln~ r1ol,UOtts OFFICER OR AUTHORIZED AOEKT ~~ NUMBER rEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (R•frnc• M •rrcnm•nra h•r•1 AMR PR~C I P LVEI~IT ; u `"L.A'. s'+ED. IF GL.A I M HPf <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used ' ' ~11S'is a-4-Par't dorm <br />?t/'n 3Y :ai:~CL <br />PAGE bF <br />