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PERMITTEE NAME/ADDRESS(7+ebMFrWryNwoeLarr,-(/D(A-t) <br />NAME <br />ADDRESS <br />"I'7KER CO I <br />FACILITY OWY C M 1 NE <br />LOCATION -N ER C O 1 <br />.LLY r1RD?R VP OF OI <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM fNPDESI <br />DISCHARGE MONITORING REPORT lO R) <br />PERMIT NUMBER DISCHMOE 1IUMSER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO- DAY <br />FROM TO <br />Form Approved <br />M I NOI OMS No 2000-0004 <br />( FUL',t-t J(. <br />F - I- iroAL <br />r:)'J;{-1 A `.SDI PON <br />Di <br />(--'(j 1 <br /> <br />#>: NO 01'SCHAROE ? <br />tJ? <br />NOTE: Read instructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />MA X i MCKi <br />r- i <br /> REQUIREMENT <br /> SAMPLE <br />-' - MEASUREMENT <br /> <br />" PERMIT <br />' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT _ <br /> <br /> PERMIT <br />: <br />ODA <br />G;'. <br /> REQUIREMENT . <br /> SAMPLE <br />- MEASUREMENT <br /> PERMIT r <br />?t -? • i ,> - <br />i I - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />_ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />~` <br />NAME/TITLE PRINCIPAL EXECVTNE OFFICER I center . prna ty o aw that tAh dorument and all atlwhments were <br />TELEPHONE <br />d <br />od <br />m <br />dlr <br />rlbn <br />hl <br />d <br />with . <br />te <br />d <br />I <br />d 1?? DATE <br />prepare <br />c <br />er <br />y <br />e <br />or wpen <br />on <br />. oceor <br />arxe <br />sys <br />m <br />arne <br />Hf d <br />for <br />to <br />urt th <br />t <br />u <br />r <br />el <br />ro <br />l <br />ather <br />nd r•Juae the I <br />ll <br />n <br />_ r ^ <br />bl <br />S <br />a <br />pe <br />sonn <br />p <br />per <br />y g <br />a <br />n <br />ma <br />a <br />o <br />L <br />wbmllled. Board on my Intfulry of the person « persoru who trtanage the snlrm, ? .s /-' ?. "' -/ • ? r <br />- <br />or those perv ro dlrertly resporadble for fathering the Inrormatlon <br />the Inforrnallon <br />- <br />, <br />• <br />e: Al wbmllled M, to the best of my knowledge and belief, true. aee,rrate. and complete. / / G 1 <br />SIGNATURE OF PRINCWAL EXE CUTIVE <br />r <br />d <br />rdfk <br />l <br />Irl <br />f <br />b <br />l <br />r <br />h <br />li <br />f <br />h <br />t <br />t <br /> g <br />an <br />p- <br />I am swan that t <br />ere a <br />e <br />a <br />or m <br />rMi <br />ng <br />. <br />e <br />n <br />ornsa <br />ion, REA <br />TYPED OR PRINTED Irwh dlrtg the possibility of fine and Imp sorinment roe knowing •lelatlorm OFFICER OR AUTHORIZED AOENT CODE NUMBER YEAR MO DAY <br />COMMENTSANDEXPLANATIONOFANYVIOLATIONS (ReforencasNarrachmenrshora/ _17 FiF{ =Rit:Ip iV?rhiT iS CLAIMED. IF CLAIM APPPOVED r-) WC <br />SEE T. A? 'C?, PG- ? Fi_ <br />1 N=TR 1'•TT1DIN' - : C I 1 <br />PAGE bF <br />EPA Form 3320-1 (Rev 3199) Previous editions maybe used -