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PERMIT-TEE NAME/ADDRESS M, hid, fini(ih %mnt 1-ari it /rl// <br />NAME <br />ADDRESS 1 : 11 NEL, <br />P in 433 <br />" i •a I +•1 <br />FACILITY _ <br />1 ± It t 1 M I N !? <br />LOCATION <br />1wIA ., <br />T I T) 1=.1 0 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />NOTF- Read Inctrimtinnc hpfnrn rmmnlntinn Chic fnrm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT n . 4- 4 1 <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t 7-! < ei: t ?;i - -{i <br /> REQUIREMENT <br /> SAMPLE :. <br /> MEASUREMENT <br /> PERMIT t'r r r 4. s .5, -` } <br />_ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a s'Ir ##. .t.. !'.. iT r•: `Ir IT <br /> REQUIREMENT <br /> <br /> SAMPLE , ., <br /> MEASUREMENT <br /> PERMIT T fi Y _ l.l!? <br /> REQUIREMENT fit, F?VG <br /> SAMPLE * ?! h s 4 y ^ . t ! <br /> MEASUREMENT <br /> PERMIT *-. - iiR T = y <br /> REQUIREMENT ;N X- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 reniq under f><.n:dl,nr I:ro nl,lt t11i. d,wnmelu .lnd :dl :uwatuneol. aen' <br />"• TELEPHONE DATE <br />/ <br />I 7' <br />' prrpand under ,,, di"'liun ..r .open Icon iu aaeurdmlvr with a .).ICm de.ignM <br />lu a*.un• Ihat . <br />l:dir-f <br />enunnef <br />ro <br />erl <br />uth <br />r a <br />d e.:dll <br />d <br />th <br />inL. <br />ra <br />li ' <br />i I r / <br />1 p <br />p <br />p <br />, <br />p <br />e <br />n <br />r <br />e <br />r <br />w <br />nn <br />y e . <br /> .ul-ina d. Ita.rrl un nn ingnira of the fMV m ur flerwn..ah.. m:w:n;r the y.lcm. <br />/ ur Iho•.a• fIa•nun. dil r:ll. rr•.tw.n.il.lr fur Z.uhrriny: Ih.• in(urmuuun. the .nfurmaimn .. _^ <br />\ <br />I whnwlt d K. h. Ih. h•.1 ..f m. knuulad¢r ..nd ta•liel. true, a..urale. and ronydelo. <br />1 .tn -.rv Ih:d Ih <br />rr <i <br />nili <br />n u:dli <br />fur .nlnnitlil <br />a <br />m <br />t <br />p <br />f <br />li SIGNATURE OF PRINCIPAL EXECUTIVE <br />' <br /> <br />TYPED OR PRINTED a <br />c a <br />l; <br />ra <br />I <br />c. <br />l); <br />e In <br />urma <br />a <br />,.n. <br />iwfudin,• the p .,.dldn> .d fne and unpt i.oaulrm for kn,..aulk .ndarimt., <br />OFFICER OR AUTHORIZED AGENT <br />R E A <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />vvl?ll?lrrl?.., ?.?v ?nrr_r?1??IIVI? VI ral? I vIVLM IIVI?J fI,CICIV1lGV all allowl//ICllla IIC/C/ <br />EPA Form 3320-1 (Rev- 3'99) Previous editions may be used I17trti.' cry 4- RTI,i_yrril.