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PERMITTEE NAME/ADDRESS (Inrrlt i,eWgNw,r Lor.rru, (/DIQw.nr)
<br />NAME
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<br />Form Approved.
<br />NATIONAL POLLUTANT OISCHMOE EUMINATION SYSTEM //NPDESI OMB No 2040-0004
<br />DISCHARGE MONITORINt REPORT ~OMR! 5
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<br />PERMIT NUMBER DISCHMOE NUMBER _ „ 1 .~ e i r o c
<br />MONITORING PERIOD - ~ r I V I: 4
<br />YEAR MO OAY YEAR MO DAY -
<br />FROM ~ TO _ ~
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<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO.
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<br />EX FAEOUENCY
<br />OF SAMPLE
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<br />YPE
<br /> ANALrsls T
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br /> MEASUREMENT
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<br /> REQUIREMENT
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<br />~,P~ ~ pR~~O InAUdin~ Lee pole1b10tr of flne,nd In+prtaonmenl for knowfnj .lol,llolls. OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY
<br />COMMENTS AND EXPLANA ~ IvN yr err T vw~n 1 wns Ixair~nn sn •rr~cnm~nra n~r~r
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<br />I EPA Form 3320-1 (Rav 399) Previous editions maybe used T}11S IS 7 3-P3fi fOfltl. PAGE OF
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