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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
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<br />FACILITY t ., F r ,,;r' {,.- : i ,._..
<br />LOCATION ~ ,ry..,1', .,.. , ` . _ . - i~ s~i i;'~ + '•(• ~~w i
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<br />Form Approved.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) QMB NO. 2040-0004
<br />DISCHARGE MONITORING REPORT (D R) ~~: : i`•aC :i'
<br />~ PERMIT NUMBER DISCHARGE NUMBER ;" • - ?"' ~' ?:'=;? _ ~ L'~=`~ I
<br />MONITORING PERIOD . `' , .':'~' •` ~- `41 ~~ '' -~- =:5`~" ~' f~',t= ~ [.: ; ~ ". ~!~~
<br />YEAR MO DAY YEAR MO DAY "°
<br />FROM 1.:' _ .. y,, .1 :. TO Lt .' ~, ,_~ ,_y ~ ?; 7: #:- i'°s ::d ~. ,~.3 : C" r .YC ~.,` ~' ~ ~ •:t3; :.'•
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<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0, FREQUENCY
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty otlaw that this document and an attachments were
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<br />including the possibility of tine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.
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