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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004
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<br />PERMIT NUMBER DISCHARGE NUMBER - _ T,. ,tL °~aL='.
<br />MONITORING PERIOD '~Da!5 `: l: "+F D5C 3!:G TC i6[; .A59
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
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<br />e. SIGNATURE OF PRINCIPAL EXECUTIVE 6~S /
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<br />TYPED OR PRINTED I am aware that Nere ere sign cant penalties for submitting lake inlonnation,
<br />inclUtlin the ssibili of fine and im risonmem br knowin violations. OFFICER OR AUTHORIZED AGENT A
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<br />EPA Form 3320-1 (REV 3/99) Previous editions may be used. THIS IS A 4-PART FORM PAGE OF
<br />')'170!1/J').;7:"!-I±;r )
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