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<br />EE NAME/ADDRESS (Include Facility Name/Location if Different)
<br />SS - ... w3' f.. . l ,.. V
<br />•iACILITY
<br />LOCATION
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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-, PAY YEAR MO-: DAY.
<br />FROM TO
<br />Form Approved. "?*
<br />OMB No. 2040-0004'`
<br />"
<br />NOTE, Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY
<br />OF SAMPLE
<br /> EX TYPE
<br /> ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAMErnTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments wer e TELEPHONE DATE
<br />
<br />?,±'??•• ?
<br />>!?"r?"i0? ?,,y?
<br />` prepared under my direction or supervision in accordance with a system designed
<br />to assure that qualified personnel properly gather and evaluate the information
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<br />/ .c= CC r Gc_ N d
<br />/ submitted. Based on my inquiry of the person or persons who manage the system,
<br />"`^••?
<br /> or those persons directly responsible for gathering the information, the information
<br /> submitted is, to the best of my knowledge and belief, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE S`bs'5" k
<br />?? y J
<br />TYPED OR PRINTED 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 NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aft attachments here)
<br />, INIEO?f? E'":N Si..sB?,i?'C TO U.gDE'N OF ?F ROO €?'Et:?)KI?ENJY .a Al
<br />t.r t ark?i,t'"k ,'sf ?'".,Nt1;1 ...f ',_' mot.; L' ..?;, 1:.
<br />t-:? 'j:.l _.I .... ?? 1?.. k'?,.. i ?r?? ... i:,..f FUR, .
<br />Jw i QT ADD -' l'.t « I, _ ot.? f3gµt 27- l 7 t , ?e "='`." _ ... ?. 1.1 T ?, o ?. 'i 1?`I
<br />19t S t ir...t; , t I-3: S;.rr Pf C) TO i?1t <f t??, ;?i r:? •?
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. if ?nS 1P 9'4'- jS11't34OT'fTl. PAGE 1OF
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