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fERMITTEE NAME/ADCRE55(1wd~~.f.ewryNw/Loc.nowl/D~..+wr)
<br />NAME
<br />ADDRESS
<br />LocATION ~-KKR :~t] 87
<br />i._L`r' ~. S:~ivD%RS. VP t~. r` OPT
<br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYITEM~ //NPDES/
<br />DISCHARGE MONITORING REPORT /OMR1
<br />PERMIT NUMBER asc-+MOE NuMeEt+
<br />MONITORING PERIOD
<br />YEAR MO DAY Y AR MO ~ DAY
<br />FROM TO
<br />Form Approwrd.
<br />M 'L N C R oMe No. 2oao-ooo4
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<br />NOTE: R~~d (rntrvctiorn b~lw~ compl~tMp thh loan.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np,
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<br />EX FaEOUENCr
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<br />TYPE
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<br />TELEPHONE
<br />NAME/'f1TLE PRINCIPAL EXECUTIVE OFFICER pnP.~.~e.,w.,~,ef,.rll~,.,~o.m~a„I,.~,d,,,nwne..,>+«~ed~~e ~', .,~ ~ / DATE
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<br />TYPED ~ PRINTED IncMrdln~ tM po,Ybllit, orllne,nd Irnpr4.onenrnl for kno.ln~ .Id,nwn OfFICER OR AIfTNOR12E0 AOEE'(T COOS NVMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /R~/~r~nci dl~tt~chm~nts hrri~J ,~ P#iE~' IF ~-V1=Nf IS Ct_AI9"tEP. IF CLAIM APPRt1VEI} f~ Y WtlC~D,
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be uxd. ThtS 44 :i 4-p.'iTt ft~~tn PAGE OF
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