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PERMITTEE NAME/ADDRESS (lacrrde Panrrry xomr//,oCatioa fpga,,,y <br />NAME <br />r•Lll ~i M~':h; AI~~ rh'c P•;Y, :•i[. <br />ADDRESSU z~ S F R h v p :' I ti ii <br />FACiun'''NGLY CJ 'sli•u~? <br />LOCATION <br />A7I:1: JEFF .l!I,~' !i'' <br />NATIONAL POLLIJTAM DISCHARGE ELIMINATION SVSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />r PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MO DAV YEAR MO DAY <br />FROM :i ~ it TO 3 <br />Form Approved. <br />OMB No. 2040-0004 <br />.In " <br />r - F'I'.h', ...LA,. <br />NOTE: Read Instructions befo!e"Ct7Fnpleting this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX of nPE <br /> <br /> AVERAGE MAXIMUM UNIT <br />' .y MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS aNALysrs <br />p~~ SAMPLE .... .~. ..:::.r .:::r ,: , :: ~: •, .. i' ( i.l <br /> MEASUREMENT <br /> <br /> <br />ti 1. f U it I '.I I <br />, V'"n. ~ Y' #~y ya <br />!. T4 ~Y.~+. N6~jyy y~ <br />'."T'gi~~~R?:: <br />" <br />~ 4~' y <br />.. . ~#rii ~ /~ <br />• V L <br /># ynyf y <br />i 'i ryr~~~~}} <br />P ~'1 4 <br />tF.°L[iF:NT 6H.i=:, Uhi.U+; flELI(ll f(NT :v.. 4 A Ft <br />':iL?US, S'OTAz. SAMPLE - -- ~~ ~~ ". ;t r•.~:ftltN~ ( ,,) <br />-;3,'L: ,y ~f,•9 MEASUREMENT <br /> " <br />v <br />:FLUEvT GRDSS VALUE .: <br />. <br />~- <br />LIi?$, SF:TTLEh!-Lz. SAMPLE .. .. .'~.f ': •! >}C1>4Ch ~ <br />') <br /> MEASUREMENT <br />,:;~y5 U U ~~i .;,t~ r+oF~11~4il~' #4rCra0e ;. #~ RT"~:> .;RE`P~R'1' CE/ RAtS <br />' F'LUii:~T c:k0°;3 V5t Uh <br />y 6MENt <br />.. :.,, m ~' . <br />)ii. i~ -; !, `.ASt SAMPLE - ~~ ,t [: r: ~: a:F Fy~14 ::[:;: ( r',} <br /> MEASUREMENT <br />~~-55L L D v , ti ~~~. o!# .o#a#trn ;-:- ..#a~+~eaFu. <br />°FLU?tiT GR0~5 YA Uc =~ `~~ -. ~•`' ~~ ~ - ~ 3' <br />i~7.'+, 70TAL SAMPLE .,. .:tr :;: :'t :, :.t ~ 1%') <br />(A :; F 4) MEASUREMENT <br /> <br />,.<.. ~" . Q s <br />«#F „ <br />,,: . <br />Y~ <br />eke <br />~_ <br />.r t LI;En'C Gk05S YA' ut' t <br />>; ~*". ,,, <br />H ... .... .. ~ <br />, <br />.`°., ,;~5 _ ,- <br />' 7a, Is CUNUUTT "' <br />h <br />SAMPLE <br />.. l <br />f 1 •. ...,... <br />~ ... .,. ,•. ;.:,...:,,. <br />'~, r. C T n ": A T ".; °_ N T P L A 1! C MEASUREMENT <br />i1.i77 1 U U y` a <br /> <br />` r,;~~g¢$1:~: <br /> <br />' ` ~t~k4ia#rs. ~bqt#~64.~ 44t+~~t2 <br />... <br />~•= ~K~'Y S'fi+il~l <br />`F'FLl!..''T ;5055 VL.LUd . <br />' ` _., - . ':.y.y.. xr x <br />IL F, 4:. ::AE.45F: SAMPLE ."a':^ ( ;l:) ..... .... ._ . <br />/ : S C A L MEASUREMENT <br />',u6o L v o ~ ~~ ~-• <br />-` _I .~xa###~x. aoaaa~x +a~t~#a# •.~:• L'~" TS~Jt <br />L <br />°FLOF,'iT 65065 U U" '~~"~ ' ~~ s ::t <br />"n <br />• ; <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICenify under penelry of saw that Nis document and all attachments were <br />prepared under m <br />direction or su <br />ernsion in accordance wiN <br />si <br />n <br />t <br />d <br />tl TELEPHONE DATE <br />y <br />p <br />g <br />a sys <br />em <br />e <br />a <br />I <br />~~ <br />Q <br />1 <br />s to assure that qualifetl personnel properly gather and avWUate Ne information _ <br />~ <br />submktad. Basco on my Inquiry at the person or persons who manage the system, v~ <br />; <br />l~ <br />~ <br />~ <br />p <br />~, or Nose paraore olreclly rasponslble br gaNaring Ne inbnnatlon, the iMOnnellon <br />E ~ r <br />'~ = <br />~ <br />r ~ / f eubmMed la <br />tothe best W my knwAedge end belies <br />true <br />ecnirrme <br />antl complete <br />` ~ 1 ~ <br />1 <br />"~~ <br />U <br />~ v <br />, <br />, <br />, <br />. <br />, <br />l em aware Net there ere <br />i <br />nifi <br />eneltiea br <br />rt <br />b <br />iN <br />f <br />l <br />i <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE J G I ri a <br />g <br />s <br />rar <br />p <br />su <br />m <br />ng <br />a <br />se <br />n <br />ormat <br />on, <br />TYPED OR PRINTED <br />Incluoin tl» ssibili ofhre end im nsonment br knowi violations. OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />wmmcn 1 a nrvu terLnnF,1 turv ~r arvr wuln l luny fnererence an arcacnments nere/ <br />!'~~ f. 7;)fnL I''~i LI9IT5 »ILL .°. •AIVr:^, p.tin _;:T"LFA.:'7.F )LIilS LI°:: drf`LI':: FO'; C=1"t;.,.14ak PkL'C1'r °V".:.:- <br />.A.1, f , FC f' 7 N7~. AIL ~ A.,. ?.'_2C•pTI'r~ ;S'F' ..,, ? ~ <br />` ="""~ E '~~` `~ .. ai.F, VII. fLY ~ABPLING <br />EP AL 3 9)` Pr vlbus etlitio r6ay be used. THIS IS A 4-PART FORM PAGE OF <br />007R3/U!?0717-1350 I <br />