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PERMITTEE NAME/ADDRESS (Include Fadary Namr/facotion ifDiffoenr)
<br />NAME :~LIJF '1DUtiiAP~ i,'.~i:~Y, iNC.
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<br />FACILITY P A Y': L Y C J u 1 `: 4 r1
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHARGE EDMINATION SYSTEM MPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (OMR) OMB No. 2040-0004
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<br /> PERMIT NUMBER DISCHARGE NUMBER F _ 4 r
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<br /> YEAR MO DAY YEAR MO DAY
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER EX OF TYPE
<br /> AVERAGE MAXIMUM UNITS INIMUM AVERAGE MAXIMUM UNITS ANALYS)S
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<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICenily under panalry of law that this document antl all attachments were TELEPHONE DATE
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<br />larn aware Nat there ere signikrent penaltlea for submitting Wise lniwmation,
<br />TYPE OR PRINTED Includlno the posaibiiiN Ol hne and imorisonment br krpwlrW Violations. OFFICER OR AUTHORIZED AGENT
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a/I attachments here)
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