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PERMITTEE NAME/ADDRESS pnclude Facility Name/Location ijDijjerent)
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<br />ADDRESS :i'1;;+ t_ ;•,<t.t. ~~ 1`~ ~t`'~.
<br />FACILITY 7 -. f .- , ,, f, ; ;_ _
<br />LOCATION 17 ,~; !,\' 4 r ~ {. iJ ~ ` :1. ~•: ;~: ~. r
<br />Form Approved.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) OMB NO. 2040-0004
<br />DISCHARGE MONITORING REPORT (D R) i.~• ~ ~ l; _~;
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<br />PERMIT NUMBER DISCHARGE NUMBER ~= -- ;= ° ~? ;?•_ ~F ~~ ~~~
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<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM L.~ +' _. l..' ?. TO 4 ~ . ~ . -., . ••'::, t`i~t !l . a`.: "l, !. is?~.. R ....._,.. ~ H ~` :.
<br />NOTE: Read Instructions before completing this form.
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<br />OFFICER OR AUTHORIZED AGENT AREA
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. k~=•:}G% S ~: P L~T'hl'S~IS ~"4 :paPt.fOlTtl. PAGE _UF
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