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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
<br />NAME :.0:4}, -' -C"' :'s {_ '_..
<br />ADDRESS
<br />FACILITY
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM -IC 3 :3 ?j i TO •? '',,i r);? w"t--s
<br />Form Approved.
<br />77 pp OMB No. 2040-0004
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<br />NOTE: Read Instructions before completing this form.
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<br />PAL EXECUTIVE OFFICER
<br />C I certify under penalty of law that this document and all attachments were TELEPHONE DATE
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<br />NAMEITITLE PRIN prepared under my direction or supervision in accordance with a system designed
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<br />IZED AGENT
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<br />1fi r3°a? 4 t pn, PAGE OF
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ` '= 1 ?,• •? ??. s
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