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PERMITTEE NAME/ADDRESS (hreMJrF.MflryN.n/Loeuren IJD~ircerr)
<br />NAME 13C.}~.~•~] f~lTSC1Ul~L~S i_..T"~,t`r~~}
<br />ADDRESS ~ C}~~ ~ ~: ~~. ~ ~} ~ I~
<br />FACILITY I3 CDIh? ~ F ~1C7. ~ C"i Z ~~
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<br />NATIONAL POl1:UTANT DISCHMOE ELIMINATION SY9TEM_ fNPDES/
<br />DISCHARGE MONITORING REPORT /D RI
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM fJ ! I ~! C) ~ TO ;r :~ c"5. ~ Y
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO,
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />~~~ ~C3C~i"c=°!~#TS I3~LCt_1~ Rr:gtilREM~NT •~•3cfiFic SIPJ~SAI~t~' `I"I~~~'Y
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<br /> to useere Ih.l go.NOed personnel properly pther.nd ev.hule the Informatlon
<br />snDmllled. Oared on my Iepuiry of the person or persoen who mnnete the rystem,
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE /~(J ~p~f • J~~ U8 d ~ ~ 5!
<br />~ 1 .m aw.re IDH (here .re s
<br />En
<br />unt pendda for suDmlltlnE bbe Infoneudon,
<br />TYPED OR PRINTED Iredereint the posslDlUty of ene.nd Imprlsonmenl for knowln` vidstlotn OFFICER OR AUTMORI2ED AGENT CODE NUMBER YEAR MO OAY
<br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (RH~r~nn M/ •tbcnm~nts h~r~/
<br />S~F_' Pc~,~"i '. ~. ~s r=C1~ II~T~,LS ~I:" 'l~ST P~~I;~.~}U;`s~. Ftl'T' (~~SUI_u~ CIF L.~TN~,'LITY fiYIrR~~~ ~~ ""f„~i=FACT", GnCIl~:ST~i f~ntC)
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. ~,~r_y•~'c~ ~~s~~~_4.~~ ~Ofltl. PAGE ~OF
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