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<br />PERMt' EE NAMEIADDRESS (Include Facility Name/Locatian if Different)
<br />L .Y.
<br />-)CILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES)
<br />DISCHARGE MONITORING REPORT (D R)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO.t DAY YEAR MO-, DAIY•
<br />FROM - -. ,.., TO _ .
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<br />Form Approved. rr'
<br />OMB No. 2040-00044 r
<br />
<br />NOTE. Read Instructions before''comp eting this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE
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<br />EX OF
<br />TYPE
<br /> ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />400 0
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<br />7-7. .7777
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<br />EFFLUENT GROSS VtAUJI-E REQUIREMENT;
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were
<br />ervision in accord
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<br />direction or su
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<br /> or those persons directly responsible for gathering the information, the information ..
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<br /> submitted is, to the best of my knowledge and belief, true, accurate, and complete.
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<br />l SIGNATURE OF PRINCIPAL EXECUTIVE ?Q 1 3 F,5,- `t
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<br />including the possibility or fine and imprisonment for knowing violations.
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<br />OFFICER OR AUTHORIZED AGENT
<br />AREA
<br />
<br />NUMBER
<br />
<br />YEAR
<br />
<br />MO -
<br />
<br />DAY
<br /> CODE
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />'t I L.d...a?ty i1- .. i?>l J_. _. - J t... ? 1=!, v (Yt:i.P , J ?V•, {.,eli ., SJ.°°.. s :? : '3 w p a tt" t'?r' 2'"' x F.o.£ -ro Y,?(.'.5.?d.,.D -• ,.t. _ f'11 q Y: t, 4_ vt }"i+'
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<br />PART 1. 0. 6. ANY A"N?t 17 1O MAL DA"t'i=1 BE SUPP'1.. ice:.°s TO IIE. &;1I V -q 9) 1,,J'N 011 T 4"N .0.5 ?-DI RS.
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0009 !• ), W4ptl S a T-? Wr?-Mrm. PAGE -,OF
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