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PERMITTEE NAME/ADI
<br />NAME ~ F 7: j ~ . .
<br />ADDRESS ~'~i )` ~'~'
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<br />1RESS (Include Facility Name/Location if Different)
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<br />FACILITY , t'-`' s 1 pis l . C` 3' ~ : ;. i,,
<br />LOCATION {~
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES)
<br />rr~~DISCHARGE MONITORING REPORT (D R)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ..."'. ~:~ T. TO ?._ i. ~ ..
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREDUENCY SAMPLE
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<br />EX OF
<br />TYPE
<br /> ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAMEiTITLE PRINCIPAL EXECUTIVE OFFICER [certify under penalty of law that this document and all attachments were
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE ~j
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<br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA
<br />CODE NUMBER YEAR MO DAY
<br />GVIVIMGIVIS ANU tAYLAIVAIIVIY Vt ArvT VIVLAIIVIY.I Ineterence an affacnmenis Here/
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ; t;Y~,~,t^t ~ : ;^y = p PAGE ,
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