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PERMITTEE NAME/ADDRESS (Include Fanlirv Name/LOC¢rien ifDif(eren9
<br />NAME ..
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (DMA) OMB No. 2040.0004
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<br />PERMIT NUMBER DISCHARGE NUMBER (. ~ ~ . w
<br />MONITORING PERIOD ' '~ - ? r '-' -S ) r1 `_ T T') ii '. L d ? ~ i
<br />YEAR MO DAY YEAR MO DAY
<br />FROM .'] ~~{ 1' TO '?j -~~= JA - ~ i- .: i:S:d F. ''. ;Y '~" ~"
<br />NOTE: Read Instructions betore~ihipleting this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. PREOUENC SAMPLE
<br /> EX OF TYPE
<br />PARAMETER aNAL~(s
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br /> SAMPLE .~:: ~i.: :: ': .. r... ( ~~~)
<br /> MEASUREMENT
<br />+ : J 1 .. A PERMIT .9t4~RtY G~ ~ #II#R$# Fit .:5 ~ 4#t### - 4,4 s ~$[y~~~-
<br />'~ t..~ .I ~ i_ ~ i.1S~i • REQUIREMENT ISIMII7TJH :7A 4N- SU
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<br />_,, ~>•'•_~ MEASUREMENT
<br />'I . ~ i ; j ) ~ PERMIT as#R#v :# +aCA~1' r:r::. '":'##?f..#P : ~ ,'~~ - '!''
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<br />i '. ) ~', l4LU: REQUIREMENT - 30DA. YG [YAI~ ':~/+- ~
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<br /> MEASUREMENT
<br />:1•; 1 ., J PEflMIT 9eD~4i0t :ip##i+t#sY - ###4#iY` R$FCiiLT RELA©xT - ~,,. $AR
<br />I J:~ ,T ` 'IJS~ V iLil ,- REQUIREMENT - - 3~ AYu i)AZ-I. M _ 2i
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<br /> MEASUREMENT
<br />~-~~:> 1 ., U 'PERMIT F+Lt 9r -0tC# ###RR9t •k4P4'Lt¢ A#$=k#~e L7 ,~17 $~L.
<br />+ T '. i 5` ti t L'.i REQUIREMENT ~ c 3 T ; k' j, .
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<br />(A = ~ ': S MEASUREMENT
<br />- i ~ 1 ! PERMIT ,7r-indk'rA uii#rk,)t ;7 xl tt tf-`Ct4 j.0 •(j pl (`~~! ~;~y ~~ .
<br />:.• i S' 'v 1 L U r REQUIREMENT -
<br />' 30 6 AYr: - M L .
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<br />,. ~, ih ill! f .:a SAMPLE (
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<br />~ MEASUREMENT
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<br />~ PERMIT `; ;:BrJdi .`~>~.~~1~" _ _' ;~• -. ##~.'' -~ #~t, +,>kt 'Y~ Y Le$~.f~ >~ .
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<br />• iL~-i '.' MEASUREMENT
<br />! ,.; J' .' PERMIT n~'k4T'4t•`{'t :eik#'ksk# ~ ~ tlt#####. t11.pQRT
<br />• .$YI.~~I...: #tLY . ~-~EF .
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<br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER ICenily untler penalty of lax vial this tlocument arW all attachments were TELEPHONE DATE
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<br />submihetl is,to the best of my knpwletlge ana belief, we, eccuraze, antl wmpleta. SIGNATURE OF PRINCIPAL EXECUTIVE _'/" ~"%~~~':,~~ ~ l :i Ir 6
<br />TYPED OR PRINTED I ern aware that there are significant penaltid for submitting false information.
<br />Inclutlin the sibili offne entl im nsanment for knowin v,olaliens. OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all ettacnmen(s here)
<br />EPA Form 332U-1 (RED 3/9~'"~revlbus editions may be used. ~ ~ I THIS IS A 4-PART FORM PAGE OF
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