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PERMITTEE NAME/ADDRESS pnclude Facility Name2ocanon i/Dijferen!)
<br />NAME
<br />ADDRESST F A P P ,. 2 ,, 1 h ::
<br />P.U. !iJe. L'~~1
<br />FACILITY V k 6 I [. '- J b l ~..2 h
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES)
<br />DISCHARGE MONITORING REPORT (DMRJ
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM i1 1 ~' 1 0 TO r'
<br />Form Approved.
<br />MIN 0 3 OMB No. 2040-0004
<br />(SOgR NM)
<br />F - FINAL .h.=°4C
<br />+O[+D RJ TG EAST BUZ'l,A3D GULC'!
<br />NOTE: Read Instructions befor,~rltpleting this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION ~ NO. FaEduENC SAMPLE
<br />PARAMETER EX oP TYPE
<br /> AVERAGE MAXIMUM UNITS .MINIMUM AVERAGE MAXIMUM UNITS '~"~/s
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<br /> MEASUREMENT
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<br />+ T i U A L MEASUREMENT
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<br />.NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER ICeniy untler penalty of lawtnat this document and ell attachments were
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<br />Based on myinquiry of the person or persons who manage the system ~/
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<br />or those persons directly responsible for gathering the inlormatlon
<br />the Inlonnation ~ 70-824-4401 O1 o4 ~: yi
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<br />subminetl is,tothe DeslMmy knowledge entl beliel, [rue, accurate, end complete. SIGNATURE OF PRINCIPAL E%ECUTIVE
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<br />TYPED OR PRINTED l am aware that there ere signilicenl penalties for submining false inionnelion,
<br />Includin Ne osslbili offne end im dsonment br knows violations. OFFICER OR AUTHORIZED AGENT A NUMBER YEAR MO DAY
<br />UOMMENTS AND EXPLANATION OF ANY VIOLATIUNJ (Reference all arracnments Herat
<br />^rLEgBLE rOL1U LI°;1' ^;t c: wAiVSU i'OR >t0Y%,24i{H PRSCIP £V;NT - SEL ALTER NA?E LIMITATIONS UNC~'I?
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<br />EPA orm 0.1 ~ (REV 3 9~)~ ~ previous a itions may be use ~ ' " ~ ' ' "' "O i _ _ L - - _ 1. I! A e.aepT Cnpu opp= ~_
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