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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
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<br />ADDRESS ~_.~;i,. ». -. I~l(5 :.a I`i ~ f_:~x
<br />FACILITY ,'t f:~--.~:':?t.~. _. g~''r(.1<u
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<br />Form Approved.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) pMl3 NO. 2040-0004
<br />DISCHARGE MONITORING REPORT (D R) C.i. y,~t,_,.-,
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<br />PERMIT NUMBER DISCHARGE,NUMBER I.. -• y ~: C `(-~t,„. ~-~ty„ ~~+'''
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '~ . ... l1 ~. TO !,i . :. f,. ; .fi. 1',(~ a ..= .~ ~•• 1' ~ ~~ r~ ._. t? ~ ' .r.~G c
<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0, FREQUENCY SAMPLE
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penauy of law that this document and all attachments were
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<br />submitted is, to the best of my knowledge and belief, true, accurate, and complete.
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />including the possibility of fine and imprisonment for knowing violations.
<br />OFFICER OR AUTHORIZED AGENT AREA
<br />ODE
<br />NUMBER
<br />YEAR
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<br />DAY
<br />cummtrvrs AND exPLArvATIVrv ul- ArvY vwLAnurvs frrererence a-- arracnments nere~
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. %3i?~ i? %'"JThi$%iS a~ 4-j1aTt.~dtlT1. PAGE ~OF
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