PERMITTEE).NA~/AODRESS~ ppr~MAF~eWry.Nlw~!Loeuren IjDlQirrny
<br />NAME ..fl~..::Fult~tl" I`I? .~1!.lu~~~r tm~_.(.:
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPOESI
<br />DISCHARGE MONITORING REPORT /OMRI
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
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<br />Form Approved.
<br />OMB No. 2040-Op04
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<br />NOTE: Road ir»truc4lor» boftx~ compbtinq thb Corm.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREQUENCY
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' «nny u er pem ty o ew that; thb doavrnent end dl ut.cnmenb were
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<br />submitted b, to the best of my knowkdLe end belief, true. nccunte. end complete.
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<br />EIONATURE OF PRINgPAI EXECUTIVE
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<br />}C 1 em swrre IhN (here ue slLnlflunt penNtles ror submllHnL hbe Infonnntlon, ,
<br />TYPED OR PRINTED IndudlnL the posslDlllty of Ilne n~ Imprisonment for knowlnL rldaUons OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY
<br />COMMENTS ~A.ND EXPLANATION OF ANY vIVLATIONS IRe~~rence s// ~tncninents ntnel
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. +.~~ t:k~ -r~ ~ C.~'-ha~'1&f~'>4 ~Si't_I'(IIm. PAGE .SOF
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