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PERMITTEE NAM£)ADDRESS (tnab{rFarWryN-'L-.tr°n I/Arffjrrtmr) <br />NAME <br />ADDRESS <br /> <br /> -- i', E rR C 0 11 <br />FACILITY 'r, r_; i IjF-S <br />LOCATION ER C L'' c <br /> VP OF M <br />NATIONAL POLLUTANT OISCHMOE ELIMINATION SYSTEM )VPDES/ <br />DISCHARGE MONITORING REPORT /D RI <br />PERMIT NUMBER DISCHMOE NWSER <br />MONITORING PERIOD <br />YEAR O DAY YEAR Ma . DAY <br />FROM TO <br />Form Approw <br />M I N OMB No 204 <br />F I1?:ril_ <br />WASit-i BAY TO W"',- <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY SAMPLE <br /> <br />EX of <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />u SAMPLE. r <br />?? I S5CI1 .'.. MEASUREMENT <br /> : <br />' M F- <br />/-)295 PERMIT Rf=F <br />&R <br />f R E+ E _. . <br />-?"?L U ` • ,f? l t r4L i_: ' REQUIREMENT _30DA AV.? L,h I L.Y M1( <br />_ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT I <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' "^"? ° " p`""y ° L. Ina Nh doroment ¦nd .u .otarnme„IS ?..? - - - ?? - '' TELEPHONE <br />t <br />t <br />i <br />i <br />I <br />h <br />i <br />e <br />- DATE <br />prepared under my d <br />rert <br />on a sup- <br />s <br />on <br />n accordance wit <br />a,yaem des <br />gn <br />d ? <br />f- to aasurt that quatlfted prrsonnrt properly gamer and realuale the Infnrematlon j, <br />sobmtttrd. Sward nn my Inquiry of the person m pervo,., who manage the system <br />. or thou persona directly responsibM roe gathering the Inronnatlow <br />the Infornrack- r )l` v 1 <br />,, <br />, <br />/? ?{ submtued b, to the br_t of my kn°wledge and beb f, trot, n nste. and contpfrte. <br />t them are d <br />nlflant <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />I ¦m a <br />e th <br />ertalttes fo <br />b <br />lttt <br />f <br />t <br />I <br />f <br />t <br />U i 7 <br /> g <br />war <br />a <br />p <br />r aa <br />mr <br />a <br />ng <br />. <br />n <br />cs. <br />km AREA <br /> <br /> <br />?{??D <br />TYPED <br />CIA i <br /> <br />Incfudtng the possibility of line and Imprisonment for knowing .tdalorea <br /> <br />OFFICER OR AUTHORIZED AGENT <br /> <br />CODE NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fRIforence sly attachments herd <br />=Pd 1 S CLAIMED. L: 'A f <br />PAGE OF <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is a 4-part form