Laserfiche WebLink
PERMITTEE NAME/ADDRESSpwerflFa+6ryN~./Lernrenf/D~rr,,,y <br />NAME <br />ADDRESS ~ • <br />:. uC~ Lw.iu <br />..1~Au~ LO d151b <br />fACll(TY <br />LocATr'oN -ilS1D~ NCriTh b SCU'rH I;1NES <br />;h i~bLISAD~ CC 41526 <br />t cr•v t v l r n t. c v <br />Form Approved. <br />NATIOtIAI POLLUTANT OiSCRMOE ELIMINATION SV8Tt7M (IIVPOf$l OM8 No. 2040-0004 <br />DISCHARGE MONITORING REPORT /OMR) <br />PERMIT NUMBER ascHAfwE NuMeER _ FI Ir A ~ <br />r; ~ . <br />MONITORING PERIOD ~~ G 1 1 C CG LJ hA ~ C ) I N >: 6 <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: R~Ittd fmtructlorr b~tw1-~~letlnp thirr form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FAEa~uFNCV SAMPLE <br /> EX ANALY~s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />J 1 <br />' PERMIT <br />REOUIREMENT ~ . <br />,. L 1 <br />' ~ . i <br /> <br />- ~ <br />' ~ J' " ' ' SAMPLE <br />t <br /> MEASUREMENT <br /> <br />• <br />- PERMIT <br />~ <br />~ <br />~ ~ ~ <br /> REQUIREMENT r a <br /> <br />' ~ ~ SAMPLE <br />1 ~ ~ ~ <br /> MEASUREMENT <br /> <br />~~ ~ ~ ~ PERMIT <br />REQUIREMENT .::: ,r,:L'• ~.. 1. 4-.-i~4=~ '_r%n2 <br />' ' <br />. <br />, C1C1•/ r.A:~ <br /> I ?v yr.t <br /> SAMPLE <br />( <br />' MEASUREMENT <br /> <br /> <br /> <br />1 PERMIT ..'•.r y.i, M~ ...: ~ ~ . <br />~ - •'' <br />~ ~ <br />~ i. / <br />~ F r'. <br /> REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />~ .. <br />n 1: r ~ :. , <br /> <br />h <br /> <br />! <br />_ : _ <br />.. <br /> <br />' SAMPLE <br />( ' <br /> MEASUREMENT <br />' <br /> PERMIT ,_:PV~T ~ _ .._ ~'LY [•.in' <br /> REQUIREMENT <br /> <br /> SAMPLE <br />t • <br /> MEASUREMENT <br /> <br />PERMIT <br />~ i~ V Y ~ i1 n <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' `rniy . r pen. q o law lh.l thh document end JI ^nschmrnu were TELEPHONE <br />d <br />l <br />l DATE <br />prep.te <br />under m~ dlrtcl <br />on or nuprre <br />lon In .ccvrd.nre wllh . f~elrm deal(ned <br />t <br />nas <br />re Ih.t <br />ueNlkd <br />l <br />erl <br />er <br />ro <br />.thee <br />d <br />d <br />l <br />IM I <br />f <br />b <br />. <br />q <br />p <br />o <br />o <br />p <br />sonne <br />p <br />y ( <br />.n <br />e• <br />u. <br />e <br />n <br />nnrul <br />n <br />~ .obmllled. hued on m~ Irpulr) a( the person er persoru who rrune(e the r <br />e1M1 <br />~ <br />_ <br />] <br />, <br />or those penorle dlrecU7 rvpoMbk for plherln( the Infor•rullorl <br />the Informalbn j <- <br />, <br />wbmllled b, to the beet of m7 tnewlyd(e .nd beMef <br />Irw <br />.mrnlr <br />.nd c»mpkte <br />% <br />• ~ ~ <br />. <br />, <br />, <br />. <br />~ <br />1 .m .w.rt U.I there .re d fNOram pen.ltfa for wbmlltln( 6tx Infornullen <br />aIONATURE OF IMiINCNAI EXE CIlTIVE '~ <br />TYPED OR PRINTED , <br />iM7udVn( IAe pvalb(lltr nr nne and Imprlsenment for Anowln( .1~l.ilnrri OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANA71vN yr nnT vl~~~ I wns 1/f1/IfMCI M •rr~cnm~nrs n~r~l <br />EPA Form 3320-t (Rav. 3/99) Previous editions may be used. TI'l15 i5 a 4-p8fl fORTt. PAGE OF <br />- .- ;' - _ <br />