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<br />otn OFFICER OR AUTHORIZED AOEIR ~DpE NuEteER YEAR MO DAY
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<br />- .. ~ - ~ Porm Approved. " i
<br />. RAna+DISCHA GE MON TORINa' REPORT lDA/R PDES1 ' 1' ~ ` ~ I . ~ ~ ~ ~ -" OMe No. 2040-0004 "
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<br />PERMIT NUMBER dseHrnoE UUntem ~' " ~,'r ,)A3. 34:3 y., el al
<br />Ct.',': 11{.:°'_ rtkt~~l~~~H.'eU'.(' .irs }r ili ..
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<br />FROM YEAR MO, D TO Y R DJ hx;:„r "~L? D.~SCt~~2.t?GF; (._...i '~`°F~ ,
<br />NOTE: Reed ImlrueEorr bdor~ comphtlnp thh torm.'
<br />ITY OR LOADING QUALITY OR CONCENTRATION NO. FREOOENCY SAMPLE -~"
<br />EX of TYPE
<br />EPA Form 3320-1 (Rev. 3/99) Previous Mitians maybe used. (} Q ~ ~ ~ y' (';j~[~q^j~~A.~~~d'rm. PAGE QF
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