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PERMITTEE NAME/ADDRESS (lncluds F'anliry Nmndforedon ijDigeren9 <br />NAME <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form ApprOVad. <br />DISCHARGE MONITORING REPORT (DMR) OMB NO. 2040-0004 <br />~, i f <br />PERMIT NUMBER DISCHARGE NUMBER ~ ~ _ ~ ~ ` <br />MONITORING PERIOD ~ ~~ ~ ' ` ~ ~ ~ ~ ~ ~ - ~ ~ ' `~'' ~` ~~ '.• C ri <br />YEAR MO DAY YEAR MO DAY <br />FROM '.lt ,}C '' TO ;?1 J.. ~~. ... - :~; p~~~ ~ -- ., :'t <br />LTC. o....A b..a... ....... 6..i..L.Tfr Inlntinn IFie In.m <br /> <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br /> EX of TYPE <br />PARAMETER ~ <br />~/S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS - <br />l i. ~". - :, f:-; SAMPLE ,. .. ( ..;) :}r: ;: r:x:c .': ;c t: .-. ~ <br />;,~L MEASUREMENT (~ U J y~Shi1L <br />..I ~ i J ; <br />~E <br />R <br />M <br />''-: <br />- ~ l~ ,^$~PIS'fl~ i ; - MC+Ot iFtlrlf.~4r# ~ Ik~ fjl 1,~ ~5.~f'):I11. <br />V ~ 1 p~~ <br />~~{~., <br />r <br />~~p <br />~Ed~inF~N~ ~ <br />' y <br />:~: ~ <br />- n <br />~ ~ <br />' <br />' <br />. ~ a5. ~, ~t 55.. <br />L ~ .L , <br />.e <br />. <br />S r % <br /> SAMPLE <br />SAMPLE <br /> M <br /> RG.4WII}iy'.la. <br />V <br />f • ~ ~ { <br />7/ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />(v'rs e.a ~ <br /> <br />4 vl mn f9. <br />~' ..L e'• .: ~ <br />5 <br />' +fi''.a.1 ~r4~.• <br />'t, v~ yyyy~~ <br />.t: }f S1~r r~.: <br />yY m„~ .. <br />~ ~ <br />G. <br /> SAMPLE <br />~ <br /> MEASUREMENT ' <br /> ~ ~/"'I~? ' a ~:2~;, . r-x- mSrs ., <br /> K,, <br /> SAMPLE <br /> MEASUREMENT <br /> G ' .~ * '~, a r'W' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> : r - . <br />~ t <br />td 'ie <br />i 4' ~r ~ <br />- .. <br /> <br />i <br />, ..t~,~- <br /> ~ ,.r x . <br />ri ~ ux ~ , <br />. <br />.. 3' <br />NAME/TITLE PRINCIPAL EXECUTVE OFFICER ICarlily under)»nelry of law that this tlowmem entl all attachmanb were <br />stem desl <br />i <br />d <br />Eh <br />tl <br />i <br />i TELEPHONE DATE <br />era <br />~ . O O n e on <br />n aaor <br />ance w <br />a sy <br />gne <br />PreParstl untlar my tlirection or superv <br />s <br />. b auure tlW gualilletl personnel properly gatrrer an0 evaluate Neinbrmation <br />erem or persons who merega are 9ysUm <br />ul <br />of Me <br />submltletl <br />aetl on m <br />lr <br />B ,/ / ~ `~~y_._- ~ <br />r <br />~ <br />c 7p..g; 4-44~')! ( 1 7 5 <br />resident/Canard) Manager , <br />ry <br />p <br />y <br />p <br />. <br />a <br />Cre Inbnnatlan <br />responsible for palhering tlw Inbrmation <br />or those persona tlirectl t <br />i <br />_ <br /> , <br />y <br />aubmttmd le, to the best of my knovAetlge antl bNlef, true, arcurete, antl rromplele. <br />l <br />l <br />tl <br />f <br />b <br />lN <br />f <br />l SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED n <br />orma <br />on, <br />or au <br />m <br />ng <br />a <br />se <br />I mn aware thm there ere slgnrfioant peneNea <br />Inclutlinp Na DOSSibiIM Of Me antl imprisonment for knowing violations. _ OFFICER OR AUTHORIZED AGENT <br />coos <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments hate) <br />.. . i .. 'I J : ? L I :. , .. L ' : ? '.' : e i !.:. - n 4 I ~ . - i , 4 : ~ _ r t' T L '. !.:. .. I ... ..: " :. :. ~ - _ - , .. : _ ~ .. 7 ': ! -. _ <br />.. rlJ':D%F '~E' F''JUF• __~. i;Ih.,.,._';T:: :]~`.'.t i.n.:). ~. ..•,.... .,: - ... ... .. - .- ~.{.-~. <br />.r <br />PA Form 33201 (R J99) Prevlol~s edi -on may be use - ~ ' ` ~ ~ ~ " ~ ~ ~ ~ ~ ~ ' .l / ,THIS IS A 4-PART FORM PAGE OF <br />~- _ 2- <br />