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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
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<br />ADDRESS ('~iY,"',,:3 t:.~~ " ~! d C.)t'~) ~ 7 :o('~^,.
<br />FACILITY ~ya~~ l i o?`~ ~ if_~~ ~ 3. ('~~
<br />LOCATION ~'U''~.1~.~~ rrr ~~ £~ ~ ~. ~:~~ ~.
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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. MO _ DAY_
<br />FROM *+ TO a"-r "r :.a'.''
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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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 />including the possibility of tine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA
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<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. ~-r,~,~>9~c~,'~~+'j%~j~,S~gs:a~~, f~}~im. PAGE OF
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