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<br />PERMITTEE NAME/ADDRESS (lnc(ude Faclliry Name/(oc'aHOn iJDi$e,anr)
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<br />FACILITY
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
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<br />OMB No. 2040-0004
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence ell attachments here)
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<br />EPA Form 3320.1 (REV 3/99) Previous editions may be used. ~ L THIS IS A 4-PART FORM PAGE l r OF
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