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FERMITTEE NAME/ADDRESS pwcLJrFu~hryNran/Loeurw I/D(Qrirenr)
<br />NAME C~ w):iCJla) ! Fs.l~l.l.l<;'~, l...t :.'
<br />ADDRESS'f-t.~;lti(~i~~l'~ ~Iki%'. ~r r'I_~. ~;~i~ 1~''~i~~.~
<br />FACILITY ~i"tlli~it~t'~lt` ("..Y~' ~? ~',{_+. 'L..('~tl'~ >"1 `Ls~1E~.
<br />Form Approved.
<br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM /NPDESI OMB No. 2040.0004
<br />DISCHARGE MONITORING REPORT ID RI ;=1;i; j'yL}y? ' ° ;
<br />PERMIT NUMBER DISCHARGE NUMBER s'= °" I''+ ~~ f4(~+~_ C,~t„~~~, 7 "'
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<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREOUENCV
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<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER t eCf1i1y ° er pem q o law that ihb doeumem and an auachmenb were
<br />direction or wpervlslon In aeeordarrte with a system deal`rnd
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<br /> 1 am aware that there are si~nlRnnt penaltln for submlldn~ htx informatlon, -
<br />TYPED OR PRINTED Indudin` the possibility orEne and ImpAaonment for knowln` rldatlole. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS ANO EXPLANATION OF ANY vIOLA71vN5 IR~f~r~nctr sn ~ttacnm~nts n~r~l
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<br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used. ~•k''-)`~`' ~• % i~l~aT4=p3T[-"fOft17. PAGE ~OF
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