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PERMITTEENAME/ADDRESS JI Ind, 1',,.din ?dl1i1.?,,r,•.?:q•,.,:: <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTA,4T DISCHARGE ELIMINATIOf4 SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR <br />FROM MO DAY TO YEAR MO DAY <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FRE U N Y <br />SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i e ; <br /> <br /> SAMPLE <br /> MEASUREMENT \?t ~i <br /> PERMIT :f:. i;3 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />n, • •. REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r a :o- <br /> REQUIREMENT <br /> SAMPLE <br />..; MEASUREMENT <br /> PERMIT R IT" 71"1 <br /> REQUIREMENT <br /> SAMPLE ; <br /> MEASUREMENT <br /> PERMIT E >h., .. ." n' <br /> REQUIREMENT -' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER Irrru ...... (x•n,J1, nn,rw Thal lbi.d,rumr'n1:mJ allwlt:rrhmeul,nrrr i <br />' TELEPHONE DATE <br />prrparr 1 r 1 - n. drnclinn or r i u i r m in 1 nav .ath a ...n•m dr .irnr J - <br />II 1u a..m r Ilrrl { r 6rird {wnrnm 1 (r ( rl ?' Ih rand <•, alu:rlr the rnfnrncWon <br />r i <br />. <br />I .ubnuur d. Il;nr d nrl nr..... ..d Ihr ....n.. or {xr...n. ehu nianaL'e Ihr .+.Irm. <br />or <br />lh <br />. rc {x•non. Juulh rr.{annildr for:;alhrriuq lhr ml'.n m;mon. Ihr udarm:Ji.•n <br />i? "?'.? <br />.Illr <br />l <br />nllll'll 1.. 1.? llll' IN'.1 .d nl. hrn rH l.•ll Lr' a11J Ih'111'f. Irlil, .Irrlr r'alr•, .I lid ,,.nl(Ilrll. ` I <br /> <br /> <br />. Inman.rn•Ihaldlercmr.ipmfuanlpenullir.r.a.ubmiuin?falv?iul.nn, <br />rli„n <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />•. <br />. <br />'J t <br />. <br />, <br />TYPED OR PRINTED indndinl;Ow pr..ibilit..,flint-.rnJimpri..,rlrnr•mrorkm.,ine•i.lali n.. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br /> CODE <br />. <br />GUMMtN1S ANU LAVLANAIIUIN Ur ANY VIULAIIONS (Hererence an artact7mentS here) <br />EPA Form 3320-1 (Rev 3991 Previous editions may be used ,((1tti, . $-4-pri ftP-Iii.