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FERMITTEE NAME/ADDRESS peYifrYryNr'Larrler yDu<ewy <br />NAME <br />AODREBS <br />FACam <br />LOCATION <br />NATIfN1AL FOIIVTAMT dtCHMO[ tuMINATIOM nrtTW NPOfS) <br />DISCHARGE MONITORING REPORT ID R) <br />PERMIT NUMBER dxNMD[ NuMeER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAY <br />FROM TO <br />Form Approved, <br />OMB No. 2040-0004 <br /> <br />NOTE: Rted Inetruotlafr belore eompletln0 ihle lorm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• UFNCV <br />~EO SAMPLE <br /> EX D <br /> 'wA<rst TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />_ SAMPLE <br /> MEASUREMENT <br /> PERMIT r,F¢'idrlE(As t* 9+3a }P4401.°, x. qc tl!6#}t19~Jp1~ ': $t$pD LZP .; <br />: t~QYI4nAL T-z 1mY <br /> <br />.REQU{REMENT <br />'~~ ;' '~ <br />- ~ <br />d;>{,„~, . <br /> <br />a . <br /> <br />... ... <br />-:; „ . <br />.~ t <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />' 4 'l ? <br />' <br />5;. ix r• ` <br />° Y <br />:~ <br />? <br />~ ...f `' %' <br /> .REQUIREMENT ~,. `~ ,; .. ,. ~ ~..~•~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~'.. ' - <br />: .,:: n ..~... -.~ :•:. <br />, ... ,~;a.. <br /> <br />~ <br /> .REQUTAEMENT :: <br />~'• # <br />t .I <br />'... ` .. :~.. ~ ,. , <br /> SAMPLE <br /> MEASUREMENT <br /> • ~ PERMIT ~ <br />~ <br />i"" .. <br /> REQUIREMENT •~ ' <br />,n• <br /> SAMPLE <br /> MEASUREMENT <br /> ~. PERMIT Y,. `. - r . <br />. is iI4 ~~~;'ti i4k" .. ps}iwt <br /> REQUIREMENT rt <br />,., <br />., ~ _ <br />i p,;,; of ;s"" , <br />o , •. <br /> SAMPLE <br /> MEASUREMENT <br /> . PERMIT.. ,~<.. <br />... .~.. <br />,.: :.-.,,:;'° .: - <br />mi., ,... :., ... ., .... <br />.. <br /> REQUIREMENT { :: , ! , . , :% <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT , l r? <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFlCER nnnr • • penu rT a .. aul ah dvvmertl rnd W .n.cemmb Wert <br />TELEPHONE <br />DATE <br /> Frtnrrttl.rrr.r alrterwn ar.p...M1wn In ..m.tl.n...lm rgrwln aey(n.a <br /> w vre ax sawere prwnM F•We„T iuaw nM er Wre IM Infenrrwn <br /> weMlletl. er.a en inf Irpulrr r IM -nan > prsere nM nwnup IM eTnrrn <br /> or IM1Ow prrwre tllrecry rvFwW M1lr fn (aaerlq ae Inrennueen. IM1e InrennuUen <br /> perrllrtl K w rM M1VI N m) krrnYdp rM hM, Ine, amrnw, eM mmFlnr. <br />Irne.un an am nrt Y <br />nlerane <br />enslee t <br />uernNa <br />hbr l <br />r <br />W <br />t10NATU1IE OF MIINCIFAL EXECITTIVE <br /> ( <br />( <br />er r <br />n( <br />n <br />smr <br />en, A <br />TVPFD OR PRINTED IMitlln(rM premy Knre rntl lnrFrlrewrnl r>~no.ln(.ianlel. OFFR:ER OR AUf110R¢ED AGENT <br />CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXhLANA I Iun yr wn T rrv~n I Ions fnnermn M erncnmenra Mrq <br /> <br />EPA Form 33261 IRev. 3199) Previous editions maybe used. This IS 8 4-P3R ~D(Ttl. <br />