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PERMITTEE NAME/ADDRESS (Include Facility NamelLocatian if Different)
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<br />ADDRESS P4~:~ i"~~ :z ~ ~~3 ^}~ 3 i~}
<br />FACILITY I ~fi ~°3 t~Cir r ?'f.3P~} S'i ~ E~3
<br />LOCATION I~~{. }~G~s %[i ~ ~ ~rc~•
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR. MO DAY, YEAR, MA DAY .
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY
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<br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were
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<br />TYPED OR PRINTED I am aware that there are significant penalties for submitting false information,
<br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA
<br />CODE
<br />NUMBER
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<br />COMMENTS AND EXPLANATIVN Ur ANY vwLAlwrvs (nererence an arracnmenrs nere~ •-
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. J +~~+ r~ s~ ,F i;' ~Il~^s=a`4=~a~#~b'ITTi. PAGE OF
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