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PERMITTEE NAME/ADDRESSpneYrfrWryNw/L«rran~/D~Qbw.r)
<br />NAME
<br />ADDRESS ~ i ,; .. _ .. , .. .., _ ' • ~ . i...
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<br />FACILITY ,; S ~ ~ ~ ,
<br />LOCATION , p A }, i ~~ ~ IJ L G C U ~ 5
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<br />NATION AI VOLLUTANT dSCHAROE ELIMINATION SY4TEM //NPDESI
<br />DISCHARGE MONITORING REPORT (DA1R/
<br />PERMIT NUMBER ascHAnpE Nu~MeEn ~ y
<br />r'
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />Fore P.pp:o~.eC
<br />~1A8 t•!c X040-000a
<br />FROM TO
<br />NOTE: R~~d IrntturNora b~for~ eoffipl~tlnp thl~ form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION n1O, FREQUENCY SAMPLE
<br /> OF
<br /> EX ANAlrst4 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br /> MEASUREMENT
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<br />NAME/•f1TLE PRINCIPAL EXECUTNE OFFICER ' cenlt~ , r pen, tr o ^. th,l thh tlavmenl ,nd ,II ^u.cnnlel,e^ oer: TELEPHONE DATE
<br />prep,rtd under mf dirrrtbn or svper•Ifon In uecord,n<e rllh . s7stem damned
<br />to smurr th^t au,Nfled personnel property L,tMr ,M eedu,te the Infersn,tbn
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<br />or Those perstrre dlrectlr rnporrl Ale fa ~,therirK the Inform,llon, the Inforlrrtlon
<br />_
<br />suEmitled b, to the hes/ n( m7 knowkd ~e ^rld heMtf, Irw. ,mr nte, ,nd compkle. ~ '
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<br />i .m ....rt ua mrn .re n fnlnc^nt pen.inn ror n,hn,luln` r.tx tnmrm,tbn
<br />bIONATVRE OF -RINC1rAl EXECUTIVE
<br />TYPED OR PRINTED ,
<br />t^~'+~!^f the p~tbml. or nne sM tmprtsonment ror tM,.!^f .td.unnt OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY
<br />COMMENTS AND t:JCrUAnA I wn yr nn, •rv-.~ t tuna Irt~r~rmc~ ~rf ~rra.cnm~nra n~r~f
<br />. _ - ,
<br />EPA Form 3320-t (Rev. 3199) Previous editions maybe used. ~ ,This is a 4-paR form. PAGE Of
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