PERMITTEE NAME/ADDRESS ((nc(edeFaci(tryName/Locar,on Jageent)
<br />NAME
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<br />ADDRESSiI ; ~ p a A ~ l) " I '.~ c:
<br />HA4CLY
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
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<br />PERMIT NUMBER ~ -~' ~1 ~ ~~ ~ )
<br />.E DISCHARGE NUMBER 1. - C I I% .~ I.
<br />Form Approved.
<br />OMB No. 2040-0004
<br />~'• L A I,
<br />FACILITY ~ ~ .. " ' = •) , .~ MONITORING PERIOD ' . - 1 :.O'I' '. T!: '; A'.'. L ", I: i::• . TI ; t•
<br />LOCATION YEAR MO DAY YEAR MO DAY
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<br />FROM ')? 1 TO i J5 ',+'.,.: •J J'~C!'F:,;c II .:~,:
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<br />NOTE: Read Instructions befole tltripleting this form.
<br /> QUANTITY OR LOA QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER EX of TYPE
<br /> AVERAGE MAXIMUM S MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS
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<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I Certiy under penalty W law Nat Nls document antl all attechmams were
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<br />TYPED PRINTED inclutlin the ssibili of fne entl im daonmerrt br knowin Wolations.
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<br />UUb15/UJ~717-1.350 1
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