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PERMITTEE NAMEIADDRESS(Intlude FaObty,Nama/Looetw it Different) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPDES) Form Approved <br /> DISCHARGE MONITORING REPORT (DMR) OMB No.204MOO4 <br /> NAME �C(, � IVF�JV� �a 1'�. S- _ <br /> ADDRESS PERMIT NUMBER DISCHARGE NUMBER <br /> MONITORING PERIOD <br /> FACILITY wA yy 4 YEAR MO DAY YEAR MO DAY <br /> P t�l C rcw�l P <br /> LOCATION FROM TO <br /> NOTE:Read instructions before <br /> QUANTITY OR LOADING QUALITY OR CONCENTRATION FREQUENCY <br /> NO. SAMPLE <br /> PARAMETER OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX TYPE <br /> ANALYSIS <br /> PLE <br /> PER <br /> REQUIREMENT <br /> SAMPLE <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> PERMIT REQUIREMENT <br /> SAMPLE <br /> PERMIT REQUIREMENT <br /> NAMEMTLE PRINCIPAL EXECUTIVE OFFICER wrory wae cerexy el law Mai m�a aoePmam ens an attaenmPma wa,e prepares enser ttx atrecaon or TELEPNONE DATE <br /> wperv¢ronm accw4arca wM asryaem aesgretlto assure Mat qualifies pwwiviel propPM flaMeraM avaluaY /I I l� r /ri- <br /> Me mi mn s e 4. Baaad rtry a q rY of In persons xMD marege Me vyalem or Musa (//�7_J )J 11�" <br /> arecM,azpo smla iw flalM irgM W.la of tionsutrnilb4 k.to Me Eestol myarewedya '/� *���// �CJ /J l� vd Ge4e1.Rmrec4d^8 Ma pov-1,p! �M Paso n M Yrwxinfl vWaOors.relres Iw suErniMn9lake SIGN iT OF MN--CUTIVE <br /> A/TYPEDOR PRINTED OFFICER OR AUTNOR�DAGENT ARIA NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS(Reference all attachments here) <br /> EPA Form 3320-1(Rev.03-99) Previous eddlons may be used. This is a 4-part form PAGE OF <br />