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PERMITTEE NAME/ADDRESS (Inebir inrWryN~rL°rurow I/D(0(wwr) NATIONAL POLLUTANT OISCHAAOE ELIMINATION Tl9TEM /INPDESJ
<br />NAME DISCHARGE MONITORING REPORT (OMRJ
<br />ADDRESS ~ ~ ~ ~>' ; L i; , ~ ::
<br />'' O. BOX if' PERMIT NUMBER o+scHMOE Nt/MtIER
<br />T t; ~ MONITORING PERIOD
<br />FACILITY 'pER MIN;`. YEAR MO OAY YEAR MO DAY
<br />LOCATION ~ G C 0 8 16 ~ ~ , FROM TO _
<br />• r'P1DND G. DU BOIS, PRES/GM
<br />Form Approved
<br />OMB No. 2040.0004
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<br />DSCHG TO E. Mii;Di_E FI_.Uf~lE GULCH
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<br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (Rderence •It ~tt~thm~nts hers/
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<br />EPA Form 3320-i (Rev. 3/99) Previous editions nay be used- ,~~;r-, ;'~ ; ~~1E&_78,~Q-~~0fTE1. PAGE pF
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