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rERMITTEE NAME/AODiiESS n+~'Ar F.eWryN~a/Lee.a,en uD1~~rJ <br />NAME <br />ADDRESS _ .. ! , <br />. DUX 14 .1U <br />.~e1D:' CC b <br />FACILITY » I Q I~ y U g T b 6 S C i1 T H r7 I n c <br />LocATION Y A L Z 5 A G~ C C tt <br />~;r1td f _ tiTi'[SL G V _ D_ <br />Form Approved. <br />NATIONAL POLLUTANT OISCHMOE E1IMINATION 5Y3TEM /INPOESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (OMRI <br />i - - `t1 <br />PERMIT NUMBER D13CHMOE NUM[IE11 - F l h n L i~ I: ~ N <br />MONITORING PERIOD -' ~' c7 B T G CG j a r? Z' ;; h 1 V c R <br />YEAR MO DAY YEAR MO DAY __~ <br />7 1 r; FROM _ TO ,;' <br />NOTE: Reed Ir»trvetlor-e betiore~co?npletiny thle form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION n1O, fAEOUENCY SAMPLE <br /> <br />X OF <br /> E ANALYSts TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ., _ _ , <br /> REQUIREMENT <br />,I,.. <br /> <br />~~ SAMPLE <br />c ~ <br /> MEASUREMENT <br /> <br />.. _ PERMIT _ - / _ <br /> REQUIREMENT <br /> <br />_ SAMPLE _ <br />\ V~ <br />~ MEASUREMENT <br />i PERMIT <br />REQUIREMENT . _..... i .. .. i - . .. :... 'i <br /> <br />' _ / n .i .. <br /> ~. ~ Irl~ <br /> <br />- ~ • ~ ~ SAMPLE <br />~ <br /> MEASUREMENT <br />~ <br />`. PERMIT :n:YarZ+ [~=3~-~` ~...;L i ~ ~- <br /> REQUIREMENT <br />i <br /> <br />. .... <br />~ ~ SAMPLE <br />( ~ i <br />.. <br />- - MEASUREMENT <br />.. PERMIT •r (71r1:~ r.?.+Cti ..i . ., . t :, ... 1 v " ?' ., <br /> REOUIREMENT <br /> ~ t~ <br />r ._ :. , 1 :. _ SAMPLE ~ . <br />.r.~.:, <br />MEASUREMENT <br />_+ ~ PERMIT ~ t c iV t ~ .- ..~ , , _ e . _ : ;, _. i . <br />..t, REQUIREMENT . ~' A L',; i. t is X <br /> <br />_~ SAMPLE ' <br />~ <br /> <br />. _ MEASUREMENT <br />PERMIT _ ~.` ^, i' _ ' is j V .' S G n <br />REOUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' """' " `r pe""f 1.. t11.t !Ab document and aU attachment were TELEPHONE DATE <br />pnrpared under mf dlrrrtlon a wper.i>ton In uccordante arltA a afatem doftne0 <br />_ to assure that quaMfled pernnnet ptopertf tatAer and eraluale IAe Information ' <br />soEmttted. bared on mf trpulr~ of lM person or penom .Ao manate fife a]rterr4 <br />or tAOae penorn dirertlf repo,dEk for tatAeA,tt lAe Information, tAe Infttrttaatbn _ <br />~ ~ ~ ~ - <br />- w~mltted b, to Ule Heat of mr knawirdte and DeNef, true, accurate. .ed compkle. l <br />1 .m .w.R t11.t Itllre .R fttotn<lnl pm.tttea for ntrmltctnt 6Ne InlnrmakM <br />EIONATt1RE OF IRINCIrAI EXECLlTTVE <br /> , <br />TYPED OR PRINTED +^~tud+nt tAe pon+enur M n"r ^nd Imprtannment ror 4rMwtnt .+"I.ur,M OFFICER OR AUTHORIZED AGENT CODE NUMHER YEAR MO DAY <br />COMMENTS AND EXPLANATION vf- I-nT vIULA - Ivrvs IRI/IrMCI M •rncnmmrs Mnl <br />- _ _. _ - -• <br />EPA Form 332D-1 (Rev. 3/99) Previous editions may be used. ~ TfllS IS 8 4-p3fl fprtTl. PAGE pF <br />