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PERMITTEE NAME/ADDRESS (Y-c&& FwMOYAfw.dLacrfon (/D(Q~) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPOESI <br />NAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS _ IVL:. i`11 i PERMIT NUMBER DISCHARGE NUMBER <br />BOX 4°3 <br />A MONITORING PERIOD <br />FACILITY NCI. 21 MI; ` YEAR MO DAY YEAR MO DAY <br />LOCATION I A FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />tSli_ , <br />F - FINAL D <br />SR; DEEP. TRL DTC OR UNMD TR I E <br />NOTE: Read Instructions boforet completing this form. <br /> NO. FREO <br />UI NCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />EX <br />O <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT _ <br /> 17, <br />:1 N <br /> PERMIT <br /> REQUIREMENT { i : py :: x I Mli <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> `, <br /> PERMIT H ?- <br />f11QRI TN <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> E: <br />E°(2 R1 <br />17-4 77 <br />-R A 13 <br /> <br /> PERMIT <br />F? <br />.`r; l L hi i; <br />i1QlUl H <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />?i;Ej;j= <br />", ,`•:7f? <br /> REQUIREMENT , <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ?.,•. ;.... <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT FPCIR <br /># <br /> REQUIREMENT • I L-Y Imo!,, <br /> SAMPLE <br /> MEASUREMENT <br /> .7177, <br /> I <br /> PERM <br />T <br /> REQUIREMENT <br />NAMEPIME PRINCIPAL EXECUTIVE OFFICER E ferlay <br />prspam " nder ' .w tha, 11 <br />d undrr w y dirvellon or wp -19 dorerme.l .nd all Ilach <br />rr+Hlon In aeeordenee with tnta .eR <br />. e)e,em designe <br />d TELEPHON E DA TE <br /> to aswr e that qualified personnel pr operly gather and r,sku.t. Ibe Inforwullon <br /> fubmilt ed. Sawed tm -7 Inqulr7 of the person or prraom who manage the f)ftf m, <br /> or `hear ersom directly responsible for fathering the Infor ll m. the Infar-s6 on <br /> wbmttt p <br />ed 19, to the best of my kno wledge and begrf, Irw, arcet rete. and comple w <br />IPAL <br />EXECUTNE .• <br /> dfl <br />m <br />h <br />si la <br />lths for wbnsilt`n <br />m ter Information SIGNA TURE OF PRINC ARE A <br />A <br /> I am .. g <br />u <br />.n Ebel t <br />em am g <br />p <br />a . <br />l OFF ICER OR AUTHORIZE D AGENT NUMBE R YEAR M O DAY <br />TYPED OR PRINTED Inchnlln g the p.asiblllly or floe .md IEmprlsonment for km.ing WaL <br />oom <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell etfechments here) <br />- t: _ r c r n T ml -r. T r- r!_l? rA :1%'rRG',cr LIY 'rIQCI`, <br />This is a 4-pan form PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used