Laserfiche WebLink
FfRMITTEE NAMElAODRESS p~.a1+F.+rrrN../L««ta ~nr~ll.+r+l <br />NAME <br />AppgE55 i.a_: c: i i ~ -- <br />$~x ae~ <br />cIA CO B <br />FACILrrv ^ 1r h~t ~ . 2 t`: I i~11= <br />LOG-TION ; I A ~p 8 <br />NATIONAL VOILtrTANT dSCNMOE ELIMINATION SY9TE7N /NPDfSI <br />DISCHARGE MONiTORINa REPORT IDMRI <br />PERMIT NUMBER ascHMOE NuMeER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />( Sl1I3R I~H ? <br />~ - >= I rear` <br />SR; D;~ER TaL. DTI OR Ur(hiI <br />NOTE: R~~d kwlTUCtltxw b~(or~ compbtMp ihh form. <br /> ,, <br />OUENCV <br />TER QUANTITY OR LOADING QUALITY OR CONCENTRATION r1O, FItE <br />OF SAMPLE <br />PARAME EX TYPE <br /> ANAlrsly <br /> AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />h' MEASUREMENT <br /> <br /> PERMIT ~ as r,-;~ • ~ _ ~. <br />- REQUIREMENT' <br />,1 <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ~ ; ~ - ~ .. <br /> REQUIREMENT _ I';i:~.~ i Ei <br /> SAMPLE <br /> MEASUREMENT <br />r. PERMIT ~.. - .:.u~ ~ ~ ~; ; •. L. <br /> REQUIREMENT ~ ._ Y r~X i"._.;; i ;i <br />r; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .,.. <br />., .r , - - r -~ ;: ~- -~ -- • , ~ )' <br /> REQUIREMENT ~ _ r ~: ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 'r a a~ . ; <br />~ <br />;~; <br />REQUIREMENT <br />"+: `.:~ <br />. <br /> SAMPLE - <br /> MEASUREMENT <br /> .. - <br />-t PERMIT - _ , <br />' Ef~'~ I , <br />, <br />J;. - <br />REQUIREMENT <br />l l_ `' <br /> SAMPLE ~ - <br />. MEASUREMENT <br />PERMIT _ ~ i•~F L.!' <br />REQUIREMENT _ . _ -; F7 t ~r'• . <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER ' "nrlr r r pen. ry ° I." thu Ihb dorvmenl .nd .u ^tbchrnenlt ""` TELEPHONE <br />prepared under nrr direcllon a.uperrflow In .ccord.nce wlth . erelern deel[ned DATE <br />le a>ovure IhH rtudllMd prrmnnei propnl7 [.1her .nd t. Ju.lr Ihf Inror"I.Ibn <br />wrsmllled. er/d orl m) Inqulrr of lM person fX perl0ro "h0 nrn.[e Ille 1rSieT, <br />or those persote dl recur reperr/bk for [.therm[ the Inlorsrutlon, the Inrorrrrtlen <br />vlsrNlled b. to the sett of mr Ano"kd[e utd beMef, trVe. .rcunte. .rld ranp4te. <br />EXECUTIVE <br />RI <br />C <br />_ 1 .rn...n a.t Ihere.re d[nlfh.nl pen.Mln hr wlemlltln[ r.Ne Inronmtbw, fK)NATL/RE Of / <br />N <br />MAI A A <br />NUMf1ER <br />YEAR <br />MO <br />DAV <br />TYPED ~ PRWTED Illaildln[ the posdslutr o<nne.ne Irnprls°nneent for tnn.in[ .Id.UOI~ OfFICEII OA AUTHORIZED AOENT CODE <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (R~/~r~nc~ dl aKaehm~nrs h~r~l <br />.-•)~t^t:- T _ t1TMC=(` T •1 ,AIM q^.~.~n`li:!l ST`S LJfI.-!'n <br />EPA Form 3220-1 (Rev 3/99) Previous editions may be used ThIS IS 3 4-earl COfITI. PAGE OF <br />--~ <br />