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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Dijjerent)
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<br />ADDRESS J~~.:M~ +`~~•'~ ~ ~ i~l~} tf~! it ~~
<br />FACILITY ~<.ii_?-':~ H~!~ 3. d. U~~ 4"`> ~ 1~1a:.
<br />LOCATION "Ty~.Ji,~~ 8a~ ~j e,~by
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES)
<br />DISCHARGE MONITORING REPORT (D R)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY" YEAR _ DAY
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<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 />including the possibility of tine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA
<br />CODE NUMBER
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reterence all attaCnmentS rfereJ
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. {~.y;;:?~af3," , '~ -" ^'t ` PAGE 'OF `
<br />Of~'i~=is=a 4-part arm.
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