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PEHIVII I TEE NAME/HUURESS (LrrhrJe h'uridry Nwndl.o.'wim, i/'DiJJr,nuJ <br />NA61E <br />HDDRESS ~ , <br />fACILI I Y <br />LOCATION <br /> <br /> <br />NATIONAL POLLIfTANT DISCHMGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONROgING REPORT (DMR) <br />PERMIT NUMBER DISI;HAROE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM C?U Y:.:' i~~l 70 UCr 1:! :37. <br />Form Approvetl. <br />OMe No. 2040-0004 <br />.:i:IJtli: 1•P.: <br />Il. iL,~.. ~. i . <br />:~{:,r~: i i ;. r.. ~;' R` ~: i'c:Er~: ~: I i. t. :1'e9':-, 1 F <br />~ NOTE: Reetl Insbucllons belore compleling this lurm. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />" EX OF TYPE <br />ER <br />PHRAMtI AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />-- .. SAMPLE ., 's ~A is ~: lr h ~ il~ ~::. tt ;i:n ~r; ;~ ~tr (~Q(~ ( l"? <br />, <br /> MEASUREMENT _~~/ ~' <br />' J <br /> PERMIT ~x~;t~n~;ia+ir ~~-il'it#-N,~ x ~:::-.. ##a##~n ~ CP R'T' '. L7F'71DNAl. ~ "I'R<_Y iFtAL <br /> REQUIREMENT .. ., ~ - C3Y'{1'R~ AVCi~ QRT'R t9~1X i'h..;, .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ `-' '$' .s~F <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ ~~'~ `- <br />" <br />~ <br /> REQUIREMENT - .~ <br />-' '' <br />~- <br />" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - ' <br /> <br />-- REQUIREMENT <br />------------ SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />~_ REQUIREMENT <br />_." ~.. - SAMPLE <br /> MEASUREMENT , <br /> PERMIT ~, ., ,q <br /> REQUIREMENT .c ~: ~^ <br />~ <br />NAME/TITLE PNINCIPAL EXECUTIVE OFFICER iCemly under penalty of law atd Nb OOwmem an0 all enerhmenta was <br />aea under m <br />tion or eu <br />Ixe <br />dire <br />eMdon ~ aumra <br />nce wM a <br />m aesl <br />r,aO <br />a /1 <br />i TELEPHONE <br />DATE <br /> p <br />y <br />p <br />ry <br />B <br />c <br />e <br />e -- <br /> b assure Net qudlxea pereamal propNy B~^r entl welua6 Vu Inlorrtatlon ) <br />~ <br />. <br /> <br />aubmittatl. Baaea on my Inquey of Ne paaon ar pereav who marepa Ne ryatam, <br /> <br />~ <br />' <br />~ : _ <br />`r / U - i1 ~ !)'_ _ / 1 <br /> p e109e paema auarny (espq'L91bIB bl BWhaeq NB MblrtlaLlon <br />Ne Metlrmetbn : <br />/ <br /> , <br />sebmined b <br />b bu beat of my xmwlea <br />a entl babel <br />true <br />emrrete <br />end com <br />lete / <br />L~~ r~ <br />~ <br />- . <br />, <br />p <br />g <br />, <br />, <br />. <br />l <br />e Net N <br />l <br />Nti <br />lllea f <br />r <br />MN <br />Id <br />u <br />I <br />l SIGNATURE OF PRINCIPAL EXECUTIVE y <br /> <br />TYPED UR PRINTED B <br />am awa <br />ere ere s <br />rant para <br />o <br />nB <br />ea <br />orme <br />on, <br />wtt <br />n <br />Innualn Na aldl, of lirw anal rlaorvnere Aor xrowl rloleuona. OFFICER OR AUTHORQED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br />:! "; !,i .~Ii Yi: I. I ;!l: Pl:l.!I'i '.;t:;. ,. .. l l~ ;; l l.:/+`:.r[ '.:i. -:I .. .:.Mil. .,~,=.i. '. ..: 1' ,U t <br />. _ ". , <br />.. .. .. .I'(. ~~i11'1 ~i;. IPi",;1i?,, .1.. ~!i.. ._ ~_ fu i:i~ .. <br />moo. ...... ~~•~n_i IGFV .'i/qql Prwvifn,c editions may ha used , . . , , ..THIS IS ~;\ q-PART FORM PAGE OF <br />