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rTt.~giTTEE NAME/AG:%'.E554nr~~/tfMhgKw9!<.-..-,..r~r~LT.....r' <br />NAME <br /> <br />ADDRESS - _. ~ <br />J ~ ~'~+ i~L ~-i~GH~~~,'I' ' <br />3 <br /> M1=rKER Cfl~ 9164] <br />. <br />FACILITY r ~~-OW YO i•: ~ '`1 i '. <br />~~ <br /> '` r.~S+~Ef2 C© <br />FlIb4] <br />IOCAT1pN <br />:~~ 1 ~~; !.<i.LLY f.;. ",<;I:_;::_~5t t er OF ~7PS <br />NATIONK VOLLUTANT DISCMMOE ELIMINATION SYBT[M (NPDESI Form Approved. <br />DISCHARGE MONITORING REPORT fO R/ M Z NU" OMB No 2040-0004 <br />_ (SU~irl ~1C ) <br />F - FINAL hit ~~ <br />PERMIT NUMBER ascM4noENUMeEw f2AI!_ LOOP f'OIvD/S.11L,ciC1N C:ttEEK <br />MONITORING PERIOD <br />YE MO D It Yfl M~"• D ?t s• - Plrl T~*``:+:~~'=''' ~__ ~~-~ - <br />FROM ..~ - _.l TO ~ <br />NOTE: Reed katruction~ b~lor• compbtirt0 thls form_ <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, fReovEwer <br />of SAMPLE <br /> EX TYPE <br /> :wALlrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />` SAMPLE <br />- = `iOL.~-'~' ~' MEASUREMENT <br /> <br /> <br />EF FLUEP~T >- G;~ a `.': jLUr PERMIT "°OGA a~iG <br />" Da X t_Y !yX ~"~_~ i L. <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 />f SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRIN IPAI EXECUTIVE OFFICER I `~^'y ° er pen• y e bw th•t Nh deevmtnl •nd dl ^11•cbmenb wen : <br />TELEPHONE <br />prrp•rrA under Iwo dltrctlon a wptnlfiew In •ccord•nc- wllh . fJtttm dedjnM ~ ~) <br />' <br />' <br />DATE <br />~ <br />~ rf I C ~'. +o nifYR u.l ga.Hnw p~rwnnei ptopeAr i.ee.. •nd e..lu.l• u. Inrornrllon <br />, _j <br />/ ~~ ~~~•' <br />~ <br />~ /~ <br />~ <br />~ ~ <br />• ~ <br />. <br />lUbllrllyd. 61wd •n m~ Inqulr~ of tbt person a ptr~onf wAe m•mp Ibe ~rflem. <br />. <br />{~ ~ <br />i <br />., <br />w Iho.e penem dl+ecfy refpelepb/e foe ~•IheArK U.. Inroem•elaw, Ibe Infoem•Ifon ~ L'v ' ~ <br />1! <br />~ rv <br />~~ ~ <br />! <br />i, <br />` ~, <br />n qt I <br />/ -:%% <br />, <br />v ' <br />a lbr bel n( mr lne.W~e ud e.Mer <br />` <br />~ <br />.. <br />~ubmllted M <br />uve <br />•ccunu <br />•nd com <br />kle , <br />C. <br />- - <br />. <br />,~> Le/~~~ r t . .C ; <br />/ f+ ..,. ,i ~ <br />f <br />~~_ <br />. <br />. <br />. <br />p <br />. <br />lfk <br />i1oNATURE Of MtINC1-Al EXECUTIVE <br />f <br />r <br />r <br />I <br /> I •m ..... un Ibere •R d[n <br />•nl pendt <br />e r•r e•b,n <br />ltln~ <br />.N <br />nronn.tl•n, <br />TYPED OR PRINTED Inew.elni rM parbtul..r nne •nd Impr4•onn+ent rce -nowlni •Id.Uetx OfFFCER OR AUTHORIZED AGENT ~~ NUMElER YEAR MO DAY <br />COyIMENTS AND E7crv~nwlwrr v~ ++^ t YIVLI"~ I Ivn~ rrtr+.r.nc. «+ at.~„++,.,.., +,.,., .;R PREC I P EVENT Z 5 CLAIMED <br />F Ct..AIM AF~PRI'11/Ea ,C3Y tJQCL <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may Lu used TAMS Is ~ -3-p:~Y1 ([~t'Ilt <br />