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PERMITTEE NAMEIADDRESS (Include Facility Name/Location if Different)
<br />NAME ~,. *i_r, ~. 1' _. -.>,.. '
<br />ADDRESS ',~,t) ., ~ ~• ;.t i ~:..
<br />FACILITY (.-,;T-.4~.~,.•~ ~ .. _, _ . i'~' i.,... ~`
<br />LOCATION r .+r,~ • ~-• ~; • : ;~•+ i ~ :~•"~
<br />Form Approved.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) OMB NO. 2040-0004 r!
<br />DISCHARGE MONITORING REPORT (DMR) ~~ •r f;;4-ta;
<br />PERMIT NUMBER DISCHARGE NUMBER ;'" t •l. y:e r r~ ;-. (;~x,f :
<br />MONITORING PERIOD
<br />YEAR MO_ DAY YEAR MQ_. DAY_ ~ .. r.•)r, !:I ~ , -s.,l~i~ y;" -a~ y ~~~ S . ~;?i•
<br />FROM r ,, ~::. TO •,.. - `- ...... ..
<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty of law [ha[ this document and all attachments were TELEPHONE DATE
<br /> prepared under my direction or supervision in accordance with a system designed
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<br /> submitted. Based oo my inquiry of the person or persons who manage the system, f ~~
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS. (Reference all attacnmenis Here)
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may •be used. .~ ~ ~ ' ~ ::a~hi'S S'• ~ 4 :p81'f.'•fOriri. PAGE -;OF
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