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PERMITTEE NAME/ADDRESS (InNUde Faciliry NamdLocarion iJDi~eren9
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ FOfm ApprOVed.
<br />DISCHARGE MONITORING REPORT (DMA) OMB No. 2040-0004
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<br />PERMIT NUMBER DISCHARGE NUMBER { ~, r ' ^ /
<br />MONITORING PERIOD '~d-t I•'-'~':"'-~~~~ -- '''C "''-~~
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~: l ~ 1 TO ? : l . .. ] J :- ~ .: ', ~(% •' ~`
<br />NOTE: Read Instructions before ~o`mpleting this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br /> EX of TYPE
<br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~'a-~IS
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<br />(~ . ~ . , , ;') MEASUREMENT
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<br />~. t . ~ 1 .: I) PERMIT ####70 4P##4~."c tps?ZtS# ~. $ 1. G' :". ~5'`$
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<br />i - PERMIT REPOc7T R6P~$'T. # _: ALfI-#rOd6-~' ;"''"-$~ i~Eip -. h#4 -+ 1f`Iil'. x1 `S- ~.
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<br />NAMERITLE PRINCIPAL E%ECUTIVE OFFICER ICeniry under panalry of law that this document and all attachments were
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<br />f SIGNATURE OF PRINCIPAL EXECUTIVE l / .
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<br />TYPED OR PRINTED I am award that there are signinrant pena
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<br />includin the ossibili eI fns and tin risonmeM for knowin violations. OFFICER OR AUTHORIZED AGENT AR
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />EPA Form 3320.1 (REV 3/99) Previous editions may be used.
<br />
<br />T IS IS A 4-PART FORM PAGE
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