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PERMITTEE NAME/ADDRESS (lxlude Facifiry Nmne/Loration ifDlj(ertnr)
<br />NAME SLUe: BJUR'[kI~ ~SF.h.Ya I9~.
<br />ADDRESS D° S ;: 4 ;~ Lt J '? I 9 '~:
<br />FACILITY H;FGLY :':) :f1E,E3
<br />LOCATION
<br />NATIONAL POLLUrANr DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (DMR) OMB No. 20440004
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<br />PERMIT NUMBER DISCHARGE NUMBER F ~ 1. ~ L - ~;' ~ :
<br />MONITORING PERIOD ~~'~ L-JA:'~~JT 'f'~ v`~S ~:A9;'
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 01 0 i 71 TO 01 J r. + ;^ ` ~: ., ., :. r :. C :: 6 h " ~ .~~ +%': y
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION
<br />~ N0. FREOUENC SAMPLE
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<br />PARAMETER AVERAGE MAXIMUM ,~ UNITS MINIMUM AVERAGE MAXIMUM UNITS auLrStS
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<br /> MEASUREMENT
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<br /> MEASUREMENT
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<br /> MEASUREMENT
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<br />(A'.1 F°.) MEASUREMENT
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<br />;: RE¢ORT .'~FrtOMAL ~ RAt~
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<br />NAME/TITLE PRINCIPAL EXECUTVE OFFICER ICeraFy under penalty of law Nat this document entl all attachmen6 were TELEPHONE DATE
<br /> prepared under my direcvon or suyeMebn in accordance vrith a system designed
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<br />L f7 L- ~~' nubmleted ia,to the best of my knowbdge end boner, VUe, accurate, and mmpleta. SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~
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<br />TYPED PRINTED lem swore that there ere significant penalties br submkting raise inbnnatlon,
<br />Inclutlinp Ne possibility of fine end Irnprisonmant br knowing violations. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />f:OMMFNTS AND EXPLANATION OF ANY VIOLATIONS !Re/erence alI attachments here)
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