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PERMITTEE NAMEIADDRESS (Include Facility Name/Location if Different)
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<br />ADDRESS ~'%~i'+ el"'i~it~.§.~~~! ~~f~l~
<br />FACILITY ~~,j~-.~{ ?~-{t~'#~4 I d f.:ir1S i~'f ~ I~I~.
<br />LOCATION ~'s;#i~',(~~}? qs~ ~~,~~~
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAS. MO.. DAY YEA.. MOS. DAX
<br />FROM '-'*-+ '-r '.'~. TO '`.'"' "
<br />Form Approved.
<br />-~ ~ ~~~ OMB No. 2040-0004
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<br />NOTE: Read Instructions before completing this form.
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty o[ law that this document and all attachments were ~ .,~
<br />` TELEPHONE DATE
<br /> prepared under my direction or supervision in accordance with a system designed
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<br />su SIGNATURE OF PRINCIPAL EXECUTIVE ( , ,
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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
<br />YEAR
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~~4~~; J ~'I'~T~b 1S»'a'4=~~~OT'ITI. PAGE OF
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