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PERMITTEE NAME/ADDRESSp~.drfewryN~./Lerenewl/D{~nwr) <br />NAME <br />ADDRESS _ _ V y - <br />dUX iy ~U n <br />~iJ~D~ ~.v <br />FACILITY ;, VSIUF. ~tOetTH b 5CUTH MIir~ <br />LO~~ :~.R YALiSADF CO F <br />Form Approved. <br />NATIONK POLLUTANT DISCHM6E EtIMIHAnON SYSTEM //NPDESI OMB No. 204o-oooa <br />DISCHARGE MONITORING REPORT (OMRI <br />PERMIT NUMBER ascHAROE NuMeER I L n) r <br />- FIhAi Ki. <br />MONITORING PERIOD % y 7 ~ C ~ L+~ h A C C F I V t b <br />YEAR MO DAY YEAR MO DAY __ <br />1 ~ ~ FROM TO -:' <br />NOTE: Reed Ir+etrvctlorr b~fwtf compbtinp thle form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, gtEOUENCY <br />op SAMPLE ~ <br /> EX ANA<YSts TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE , <br />t '~ <br /> MEASUREMENT <br /> <br />" PERMIT <br />~ <br />•'; L '! <br />t~ .; i i •_~ <br /> REQUIREMENT 4 <br /> <br />' - SAMPLE <br />' <br /> MEASUREMENT <br /> <br /> PERMIT / ,; <br /> REQUIREMENT <br /> ., <br />• <br />~~ SAMPLE <br />~ 1 <br /> MEASUREMENT <br />. .: c r: r, r,~ n i : ;:: c 1:.::: :~ ~.:: / _ <br /> REQU REMENT <br /> ~ ti <br /> <br />' ~ SAMPLE <br /> MEASUREMENT <br />~ <br />• <br />' PERMIT - , <br /> REQUIREMENT <br /> •Ir r <br /> <br />` SAMPLE <br />1 <br /> MEASUREMENT <br /> <br />_ PERMIT <br />REQUIREMENT ~ -: ,, .. . <br />"=. ~" ` <br />. <br />• = r• 1 3 ' <br />~ i - ~ <br /> s <br /> <br />.. ' ~ .. ~ ~ SAMPLE ~ <br />' <br /> MEASUREMENT <br />~. .. . ..;vl Y.. <br /> <br />1 PERMIT <br />REQUIREMENT ,. ~•Ut .~. ~1-L R i <br />_ ... ., .. .. L Y ~ ., .:t <br /> <br /> <br />• `• • ~ ~ SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT i. 1 t.. ...', k Y Z 5 U P. <br />REQUIREMENT <br />, <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' ceniq . r pen. ry o Itw tAtl thH documtnl end VI e11KAmenlt .rrt TELEPHONE DATE <br />prtprred under m~ dlrec Uon or wprrvlyon In rnord.nrt with . t~etem detl~ned <br />to asart thN ~urNfkd prrwnnet properl] [.then ^nd ttelu.le Ihr Infnrmallon <br />ruDmitled. Fred en m~ Inqulr) er the person a prawn who mrnr~e the eretem, <br />or throe penorn dlrecll~ rnpotdbk for ~.tAcAn~ the Inrormatlon, Iht Infotmrtfen <br />wtDmltted ht to the trot of m~ LnowW~e rnd Detlef <br />trot <br />arvrsle <br />.nd com <br />kle <br />~ ~ / <br />- <br />, <br />. <br />, <br />p <br />. <br />1 e1n rw.rt urt then ere stEdM1UM pendee /or wtDmltNnN frNe Informrtlon <br />EIONATVRE OF Mi1NCIPAI EXECUTIVE <br />TYPED OR PRINTED , <br />Inchdlnt ttx pocdhllll. of Nne end Imprhontnent for kno.in~ efd.Uotn OFFICER OR AUTHORIZED AGENT CODE NUMEtER YEAR MO DAY <br />COMMENTS AND EXPLANATION yr ~nT vlu~~ 1 Ives Ifraerencl M Irr~cnmenrs Mrp <br />EPA Form 3320-1 (Rev. 3199) Previous editions maybe used, T~i1S;15 3 4-pBfl fOfiTl. PAGE OF <br />. / - _ - . <br />