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PERMITTEE NAME/ADDRESS pweLlrF«WryNw/L«~troh (JDIQirenr)
<br />NAME ~' h. .d?v-=i ;`y _ '! _ , , ;~, i_i_._C:
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<br />NATIONAL VOLLUTANT OISCHAROE ELIMINATION SYSTEM //NPDES/
<br />DISCHARGE MONITORING REPORT IDMRI ; ?'I;':,~~:1~2C~
<br />PERMIT NUMBER ascHAROE NuMeER
<br />MONITORING PERIOD
<br />YEAR 0- DAY YEAR M;O-, DAY:
<br />FROM ,.,. .. .. TO , . ._,_ ,.,
<br />Form Approved.
<br />OMB No. 2040-0004"'
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<br />NOTE: R~~d irntluctior» b~itx~ complytiny thb itxm.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO,
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' "^"y " er pem ly o law thet th
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS ~RIt1/InC1 ed •ttachmtrnts hlri~J
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<br />Previous editions may be used.
<br />EPA Form 3320-1 (Rev. 3/99) ,_y~ t i• t (. ;~ t :~FN1S(i';i$ 4-~$~(ir¢I'(p, PAGE ;OF
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