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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
<br />NAME (f:~~.t"°.+~~.~'clt~ ~~~~ ~ '° ~~!_.`~f'~~i~S~, ~.I...~
<br />ADDRESS ~~~lti! ~'~~ ;~ ~~~ Idl ~ i'~I~
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<br />FACILITY PK~&~# `.,~~~~ ~ ~~~,~ ~ ~I~l~
<br />LOCATION 10l~.~~I..f~ ~p~ ~~.~c~..~'r
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES)
<br />DISCHARGE MONITORING REPORT (D R)
<br />C JC~f,~QG~ ~ 3 I~dE~3 7. 3
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEA. MO DAY
<br />FROM ~ ~~ y TO ~'
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty of law that [his document and all attachments were
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<br />COMMtrvls AIVU tXF'LAIVAIIVrv Ur AIVY VIVLAIIVrvS (Ffererence a1f arracnmenrs Here/
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~~,;~~?~/~'dT'+h'~s~s ar4-p~rt`~Ciriri. PAGE OF
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