PERMITTEE NAME/ADDRESS (Jnclude Facility Name/Location if Different)
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<br />LOCATION ~'~,iia~C.~Fw..'-'t '~<`~, F~~~~2r
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<br />DISCHARGE MONITORING REPORT (D R)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY., Y R, MO D
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<br />Form Approved.
<br />OMB No. 2040-0004
<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY
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<br />i SIGNATURE OF PRINCIPAL EXECUTIVE ~b *'
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<br />I am aware that there are significant penalties for submitting false in
<br />including the possibility of tine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER
<br />CODE YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments Here) ~ ~ ~ ~ ,T ~ ~~~ T
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<br />4`3:"i~`r~'+. 1 r't,~`rliiS-'fS`14"=~ait~~drn1. PAGE OF
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. P ~'
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