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PERM{TTEE NAME/AODRESS pneib irrtyN../Loe.nat (/D(Qir..rsrj <br />NAME <br />.. . <br />ADDRESS <br />..,. bU~ 14jt,.. ~ _ ._.,.._ <br />..15ADE C~ t3i5~t <br />FAC{IITY <br />+DSiDE NORTH ~ 5CUTH t4iN1:.:; <br />LocAnoH ~H FAL1:;Apt CQ G1~lE <br />r cnty t _ tcrt~ntc v c <br />Form Approved. <br />NATIONAL pOILUTANT DISCNMOE ELIMINATION SYSTEM //NPDE$l OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT /OMR1 <br />~, r. <br />PERMIT NUMBER ascHAnoE wulueEA ~ _ ~ ~. I ~ A L ~ ~ S tf <br />MONITORING PERIOD -- ~ G 7 Z ~ CO i0 Fi;, t C P~ I ~ E n <br />YEAR MO DAY YEAR MO DAY _ <br />FROM TO , <br />NOTE: R~~d Irntruedorn D~for~ compbtlnq thb form. <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. FAEOUENCv <br />SAMPLE <br /> o~ <br /> EX µje,Lr~s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - <br />~ " ' <br /> MEASUREMENT <br />_ PERMIT <br />~ <br />~ <br />- ~ L <br /> REQUIREMENT <br /> <br /> <br />-~- ~ ~ ~ ~ ~ ~ SAMPLE , <br />'- <br /> MEASUREMENT <br />. 1 PERMIT .. _ . .. _ '- / ... _ <br /> REQUIREMENT <br /> ~~ . <br /> <br />• SAMPLE <br />~ ~ <br /> MEASUREMENT ' <br /> <br />. <br />, PERMIT <br />REQUIREMENT X ~ ~ v :~ ~ <br />_ <br />1 :. <br /> <br />.. •_/ ~ a ~ .e ` ~~ ~ ~ ~ ~ SAMPLE <br />I <br /> MEASUREMENT <br />. _ ... -. <br /> <br />1 ~ PERMIT <br />REQUIREMENT <br />:.... <br />.•, ~- k C; n i <br />- - <br />-:~. ~ a .. <br />~~ -• - <br />,.. ' 1 ' <br />:,~ ; n <br /> r <br /> <br />` SAMPLE <br />~ ~~ <br /> MEASUREMENT <br /> <br /> <br />J - PERMIT <br />ENT <br />REQ <br />RE .s•:.r. ...L., 1 --:.~;.~'fi: -, :~: r, i'-Cc•L~ UI`,~f•, <br /> UI <br />M <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' ""'t• ° er pen. ry o lee. thu thls dxsment end vl etlsKhments erere <br />TELEPHONE <br />DATE <br />prepared under mr dirrrtbn a tuperr4sion In uccord.nce ~Ith . sTsttm designed <br />to more 1hN qudlntd personnel property ~etMr end er.hrete the Infortstatlon <br />wrbmltted. 6sexd en my Inquiry of the perwn a persoro who rsun.~e the sratrm, <br />or those persern dlrertlr reporsslbk for pUMrK the Inforsrutlost, the Infon+ntfon _ <br />submitted b, to the bet or m7 knoerkd~t end beaef, troe. emrnte..rW rompMte. ~ ' ~ i <br />1 em ^.ere U1H (here ere st~Nnnn1 pendtle for wbml RlnR fsNe Infonrutbn <br />610NATVRE OF MIINCi-AL EXEt:UTINE ~ <br />TYPED OR PRINTED . <br />IrsefsdlrK tlx poadblatr of nne.nd Imprhonmem r~r -n<,.i~f .Inl.{{prry OFF{CEtt OR AUTHORIZED AOEI(T A A NUMBER <br />CODE YEAR MO DAY <br />GOMMCfV 1, AnV ~nrsr~nn t tyre yr rsre r • rv~n ~ rvrea In r,r rr r/ncrr mr ~ss~urrnsrnta nor ~~ <br />_. - - -. _ .. ,c`•-:~". r:-;i;CI F. tV~ti: _ Ct'U: ~, S~;_,.ECT ~i - f,. ; `F LF L;tCF <br />EPA Form 3320-1 (Rev. 3199) Previous editions maybe used. - ~ . ; This is a 4-part form. PAGE OF <br />