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PERMITTEE NAME/ADDRESS pnclude Faciliry Namellucanon rjDifferenq
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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 />NOTE: Reatl Instructions befo~2`ebt7lpleting this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS aNaLYSIs
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CerVly untler penalty of law that this tlocumenl and all attachments ware
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<br />b SIGNATURE OF PRINCIPAL E7ECUTIVE ~ 7 '/i Oy G~ L(.
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<br />indutlin the ibilf of fine ana im risonmem br knowin violatlons. OFFICER OR AUTHORIZED AGENT
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<br />EPA Form 3320.7 (REV 3/99) Previous editions may be used. ~ ~ I; .)) C n / 0 0 J 71 jHIiIS A 4-PART FORM PAGE OF
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