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PERMITTEE NAME/ADDRESS(/-"Faf4bryNr?L-mi-(fDW-?U <br />NAME <br />ADDRESS ,;Y•.. ;U <br /> <br /> <br />FACILITY <br />OW11,0 1"? ! f u r - <br />L o c A T 1 G N a l e <br />d <br />Form <br />NATIONAL POLLUTANT DISCHMIOE ELIMINATION SYSTEM //NPOESJ OMB No o 204 A 20400004 <br />DISCHARGE MONITORING REPORT WMR OMB <br />?- I ' f•? r r? <br />PERMIT NUMBER DISCHARGE NUMBER _ F T NAL ? if <br />MONITORING PERIOD j^ <br />I 157 <br />YEAR MO DAY YEAR MO DAV • "- ??? r:N n J / /? Jt 0IL ?? <br />FROM - - -- TO n " <br />t, ~ NOTE: Reed Inetructione before completing thle form. <br />. r_ <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br /> <br />EX <br />FREQUENCY <br />OF <br />Z <br />SAMPLE <br /> <br />TYPE <br /> AN <br />ySfs <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REPORT REPORT <br /> REQUIREMENT 200A AV X <br /> Y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />y-•r <br />~?. <br />- <br />-- SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <br />NAM !TITLE PRINC /LL EXEC E OFFICER Iferlrq . v p`n. tf o I.. In.-1 this di- . m .nd .n'°"h, is w. <br />n or s <br />rrYly <br />n In <br />le <br />di <br />H <br />cco.d <br />rllh <br />d <br />l <br />rd <br />d TELEPHONE DATE <br /> p-P.r. <br />under mf <br />rrc <br />up <br />o <br />. <br />.nee <br />..7. <br />m <br />e. <br />?n <br />o , ?; i <br />? <br />C <br />17 1. a @,r Ih.t qu.Hfled personnel propedy L.lhrf .nd ee.lu.tr the lnfn tton <br />In <br />ulr <br />d <br />m <br />f th. <br />.- <br />or <br />h <br />- <br />the <br />lem 1 y ? <br />L <br />? <br />r g <br />T o <br />y <br />p <br />% <br />penom w <br />n ma <br />te <br />lys <br />, <br />wrbmllted. b w <br />on ? <br />? <br />, <br /> <br />/ <br />, or thaw penom dlrw lf -pomlbk for plhrring Ihr Info 11-, the Inforinalnn <br />I <br />I, f- ?11i / % %' '.? <br />• " ?? <br />fF .ubmlllyd IL to the bet of my Ynewledge ¦nd better. Ime.. r.tr..nd tmnpkte. <br />SIGNATURE OF PRINCFPAL EXECUTIVE <br /> 1 .m .- thel lh- sm slgNfk.nl pen.lne for.ubmlltlnig Ww Inrnrm.Uen. AREA <br />TYPED OR PRINTED Inca,elnf the poWbluly or nnr.nd lmpmonmeM 1" km lnf .l.l.un OFFICER OR AUTHORIZED AGENT NUMf1ER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fReference off •rrecnments nerel <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be'used This IS a' 4-Part form. PAGE OF