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1'ERMITTEE NAMFIADDRE55 p.iiF.YryMr'f.°w.. yOldL.ne/
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<br />PARAMETER
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<br />Form Appravrd.
<br />NATIONAL FOLLIRANT DISCNMOE ELMINATON IYSRDA_ JNPDE'Sl OMB N0. 204b0004
<br />DISCHARGE MONITORING REPORT /O RI ~ C ~
<br />PERMIT~NUMBER dSCNMOF NuMlDI E f I h H„ P 1 ~! Y. .r
<br />MONITORING PERIOD-'~~T~MihltrG NUyOF: S..il= :'U?iu
<br />YEAR MO DAY YEAR MO DAY
<br />FROM C TO U L ~~ NO DiSCNARGi ~~x~/s/ ;"~~
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<br />QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, of SAMPLE
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<br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAME/iftLE PRINCIPAL EXECUTIVE OFFICER "r" t" ~ F""'r ° "'"" r"" ivianin1n0 i°'"'d""`"" ~"' TELEPHONE KOATE
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<br />COMMEN75 AND EXPLANATION OF ANY VIOLATIONS /Re/erenee eA' efhehmenh here/
<br />,~TLEAcL~ 30LiD5 LI(1IT WILL LsE w6IYdu FGiL 110-YNt G4-hH P::aCIi' ~Jc .1-:rLI: i.~..~F PG IVt FJF. icEtiU.kI:'ttt+T..,.
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<br />EPA Form 33241 (Rev. 3/99) Previous editions maY 6e uscd. 0 ~ 1, •,r `.i / OT'(I~,1~ ~ 4-Pari ~~~' i
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