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PERMITTEE NAMEJAODRESS(r~.eb/rf.r+h4N~..'Lx.llon~/D(Qi..nr) <br />N A l+tE - <br />AOORESS <br />~7:3i 57k i ~ ttli:+:Wr1Y - <br />FACIIfTY •~ .;-i v ~? D•1 T idI= <br />LOCATION ~ ;. ? 1~ 0 $1 <br />. ..... ._.-. ... , . ..~ ~nr <br />NATIONDISCHARGE MON TORINQ REPORT DA•IRI~ESJ <br />PERMIT NUMBER gSCHMOE Nt1MlER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY- <br />FROM TO <br />Form Approved. <br />M z NOS oMts No. 2040.0004 <br />~ aUgf~ ..}C ) <br />F - FTi`~AL • <br />pR05PEt',7 SL-O PD! =r.~OD ~-:r•R IN6 <br />N[fTF• R••d in•tructlorn b~for• compl~tlnp tfib term. <br />TER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FnEOUENCr <br />OF SAMPLE <br />PARAME EX s TYPE <br /> ANAtrs+ <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ <br />I ~ ,/ ~ .. ~ _~; `I~ : ~ t~,'t <br /> MEASUREMENT . - <br /> .- ~ <br /> PERMIT <br />' ~ i <br />`'' <br />P ! . ;' :~ <br />'`'~:;; I i'1Ui i 1 <br />~'I~NT <br />=r _ <br />REQUIREMENT <br />; <br />, <br /> SAMPLE ---/- 7 / ~ 1-. 1-=~~"' .~ <br /> MEASUREMENT <br /> <br /> PERMIT <br />~ CiL~A i'~v': <br />i'.-:~ +1 r, <br />i <br />i'1.)I'•i <br />_t REQUIREMENT <br />' SAMPLE - e'_ 1 ~~ • ~~ - --, (r-~ ,,y~l,. <br /> MEASUREMENT • <br /> <br />• - <br />' <br />' PERMIT to ~' <br />;iC F :',`.~•,~ ~ <br />Ora l_'r MX i.- ! ! !'!(-1i =' i F <br />~;_ % <br />i_ <br />`~`~ REQUIREMENT - <br /> `! ~~ J 5~"~ ~• <br />„- , . .. MEASUREMENT ; - <br /> <br />' PERMIT - <br />".a:UA ~Uc~ <br />UA1LY t'fX <br />~^G. ~_ <br />I^t7~~"ft <br />`a, ~ REQUIREMENT - - <br />r. - SAMPLE Y .. w~ ~ -~ ,~ r~ i_,, <br /> MEASUREMENT - <br />.1-.• ._ (-' r•` PERMIT - - .. ~ .. _ _ <br />~ 19AX .- <br />h1'.~ %L <br />G>=r: <br />I ~ ~:-• ; , -i; ~ ~ - REQUIREMENT ' <br />_v.. i.: ~. ;.; .~ SAMPLE <br />' 7 7 -•r~ ~;~(~SiwV <br />..:L1 TFlE.=. CMFr: ; ,'~. r'-'': MEASUREMENT ~J. <br />~.:r~. <br />~ # 3: ~• ,~'~- <br /> _ - .. <br />~ .. <br />'~ PERMIT - <br />OUA ., - <br />~ t+#itr•u- MtliJ7f• <br />_ (~ ~- - : ~ ~ _, <br />_ ~ REQUIREMENT _ -- - <br /> SAMPLE J ~ <br /> MEASUREMENT __ _ <br /> PERMIT I <br /> REQUIREMENT <br />PRINCIPAL EXECUTIVE <br />T OFFlCER ' R^" / " a"•'~ ° ^- Ihel Ih b duvmrnt e.d eu •u+chm <br />i <br />l tab +cn <br />l <br />d <br />d ,_I <br />; - ~ ,~ ~ ~ <br />' TELEPHONE DATE <br />LE <br />NAMERI <br />~ f <br />on In ~ccord~nte wllh ~ sJt <br />em <br />edtne <br />pnp~red undo m/ dl,etllon or fuperv <br />to tawre IMI queMflM ptnonnel proptAl ~elhtr and erefuete the Informelbn ~ <br />/ ~~/ <br />v / <br />i ~~ <br />i <br />f <br />: <br />/ <br />,. H _ <br />~'-. - <br />,~ <br />~ fulmllled. Grid en m/ InQulrr of Iht pens, or penuro .ho nt•we~e the >>stem. / <br />~ <br />/~ <br />, <br />~ <br />7/ j <br />_ ~ ~ I/.'(/ ~ <br />: r`~ <br />~ ~i~~ • I <br /> <br />or Ihox peswm dlrecll/ nrpe~b4 for plheArK Iht Inrornullen. Iht In/ernrllnn . <br />.. <br />f ~ ~' /y <br />N ~~ Q?~/-/~ _ <br />~ /1(/ '~ ~- <br />e <br />~ <br />~-~ 1 <br />/E• I~/i~' E ~ •` f•hnrtled Is. to Iht hni of me Lne+kQEt end EN{ef, Irot, ~[tvnle, end eompklt. N <br />ECtITTVE I VU ` v <br />- <br />C_-• ~ /Vt/< ~ / 1 ~m ewers lhel (here ert dEn111nn1 pendlle Ior wAmlltlnj feMe Inrornntlon, SIONATVRE OF -RI <br />prAI E7( A A <br />NVMEfER <br />YEAR MO DAY <br />TYPED ~ PRN~ITED Includin= the pnriD1111/ of fine end Impr4fpnmenl for kno+In~ .teteuoui OFFICER OR AUTHORIZED AOEKT CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS/RNA/~nc~tan~rrscnmrnrsnrrr~~ a f'R;_GIP i^VEPIT I8 CLAI"`f~G- IF C.I.ATM AFP`Z13VFP !{Y ~?L~tt~i3, <br />-. - - - ._ JEF~ .. .. F' 1 in .--,>=~ cif i' 1Z' (-1.~~~ r. <br />~- - ThIS tS a.a-r,•+r~ forth PACE OF <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used <br />