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PERMITTEE NAME/ADDRESS pwrrisrWryN~r~Ler.na~wr) NATIONAL POLLUTANT DISCHMOE ELIMINATION SY3TE1~1 /NPDESI <br />NAME ~~/~~ DISCHARGE MONITORING REPORT IOMRI <br />ADOaess ~~ ,~ 0.~~00 a~~, <br />PQ~ o~~~~a~0~ PERMIT NUMBER aSCHAAOE r+v-,lecn <br />FAC-Lrrv O~~~S\o~~ MONITORING PERIOD <br />~,(~"~" YEAR MO DAY YEAR MO DAY <br />1O~-Tb-+ FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: R~rad k+~trucNoM bt[1w~ compi~tlny this fofm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX rncouENCr <br />of SAMPLE <br /> <br />TYPE <br /> AN,tivss , <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />. <br /> MEASUREMENT ' <br />i •- <br /> PERMIT . # ~ ii ICI?. O~~' tsi t .t -,r <br /> REOUIREMENT (~(~ `I F;_ . <br /> SAMPLE <br />AS <br /> ME <br />UREMENT 1~ <br /> PERMIT ... ;t ~ i ~ ~ ~,~ r7F ~ Q ;i .....--t <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 /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />AME/TITLE PRINCIPAL EXECUTNE OFFICER ' eentl) . er pen. t) ~ .. Ih.t thb document end .u .u.cnmenLt .rr~ <br />TELEPHONE <br />DATE <br />ptepa red under m) dlrxtlon a aper.Mon In .crnrd.nn rlth . f)rlem dd[nrd <br />N <br />to tenure Ih el aueefhd perwnnet ptoperl) [ether •nd t•elu.lr the Infornullon <br />^ubmltled. H.wd on m) Iwqulr) of the persar or persona .ho rrrne[e the t)rtem, ~ ~ - __ ' ~ <br />l <br />f <br />~ _ <br />or Ihose panacea dlrrrt <br />. resporrdbk <br />a [Nhertrr[ the Informslloa, Iht In/ormsUnn ~ <br />wbmltled lf, to Ihr belt of m) tnowkd[e .cad btMef, Irve, .rcvnle. end complete. _ <br />l <br />Mfl <br />l <br />ltl <br />aIONATVRE OF -RINCIrAI EXECUTIVE <br />l <br />t ~ ~~ _ <br /> on <br />a roc wrbmilf <br />I sm swsre U1N Ihrrr en f <br />[ <br />pen. <br />n[ r. <br />se Inronrtat{on. A <br />~ <br /> <br />TYPED OR PRINTED Incfudln[ the poalblllt) of floe ^nd Impr4sonmenl for tnowln[ .Idstlor~ OFFICER OR AUTHORIZED AGENT NUMBER <br />' <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rf,ffrr~nc• NJ •tt~chm~nts h~r~l <br />EPA Form 3320-t IRev 3+99) Previous editions maybe used This is a 4-pan form. PAGE OF <br />