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PERMITTEE NAME/ADDRESS pnclude Fadliry NamdCocarion ifDifjerent) <br />NAME , ~..i ~_ ....`) n ":, I . ., Y , : Ir ~ . <br />ADDRESS.r :, ~. q n~ 1 .1 <br />FACILITY ~. ii ~ • L }~ ' ! ,- 1 ~, t <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHAgGE MON170RING REPORT (DMR) OMB No. 2040-0004 <br />T` <br />:-t 'l ~y,r ~;, .fir, .. , <br />PERMIT NUMBER DISCHARGE NUMBER ` ~ _ 1 ~ ~) <br />MONITORING PERIOD r -~' 1 '~ i " . :~ A '; Y.' T : ' .°. D l• 9 .> <br />YEAR MO DAY YEAR MO DAY _ <br />FROM IIL '~' TO '~i it ~~~~~ ~~ '.i'~: ~-S'•.; ~~~ 44;f <br />NOTE: Read Instructions before completing this form. <br /> OUAN7ITY OR LOADING QUANTITY OR CONCENTRATION NO. FREgUENC SAMPLE <br />PARAMETER EX OF TYPE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS avatysls <br />:1 i. ~?~, ., ~ `:1.~:' SAMPLE Cr .: .. ~ .!I) R;: f,: ~~: ::i=:::-7 ... <br />Y : , , i ;. MEASUREMENT <br />1 . _ t U PERMIT -+DOP4R# 0 - ~ .'-1 RHO#p# 3##~#R: ;~"+h:::4q t, .~;;t `: ~ <br />~ .TS{3R <br />~ ;; : '! A i, fl _' REQUIREMENT - L.N 5'P !I a- X E:- n ~ - .. <br />~:~>< . <br />~ '' . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. ~ - ,. ° , .• <<~ ." - . <br /> EAUIREMENT --------- -- ~.: „~.,;~'. k', <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ' PERMIT .. <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ,. <br /> SAMPLE <br /> MEASUAEMENT <br /> PERMIT ~ ~ ~"~` " ~ <br />'" ~ _ `" ~! <br />~' -- <br />' <br /> REQUIREMENT - . <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PEAMIfi _ "... - - <br /> REQUIREMENT - ' <br />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I Cen~N untler penalty of law that this tlocumant and all apachmems were <br />aretl untler m <br />tlirection or su <br />ervision In accortlance with a s <br />stem tlesi <br />re <br />netl TELEPHONE DATE <br />_ _ <br />j <br />/ <br />/ <br />b /7 ` <br />r f ], y <br />g <br />p <br />p <br />p <br />y <br />/ <br />i, <br />i <br />. to assure that qualifietl personnel properly gMner anE evaluate the Inbrmatlon ~~_ <br /> submittetl. Bazetl on my Inquiry of the person or persons wDO manage the system, i <br /> or those persons tlrrecfly rasponslDle br gathemg t/u Wormalion <br />the Intonnahon ~ ~~ <br />, [ ~ <br />I/ ~ I i , <br />submitted is <br />to the Dest W my knowletlga antl beliel <br />true <br />accurate <br />entl complete r ` <br />1 ' ~" % ~- r/ 1 <br />~~ <br />p <br />, , <br />, <br />. <br />, <br />, <br />I am aware that Nere are si <br />ndicanf penaWes br subminin <br />false Information SIGNATURE OF PRINCIPAL EXECUTIVE J ~ <br />' -~ ~% G ~ z <br />TYPED OR PRINTED g <br />, <br />g <br />n <br />l <br />th <br />siblli <br />l fin <br />tl im <br />n <br />n <br />tli <br />i <br />t b <br />k <br />i <br />l <br />L OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br /> i <br />c <br />u <br />n <br />e os <br />n <br />e an <br />r <br />so <br />men <br />r <br />now <br />vro <br />a <br />O <br />s. D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />I'~] .'aidi, in: L.T:rl',_ ~[~.. -.. -.i'J :. ~, .r r ',":! ..,.. 'S1L~ ~~ i Pf~-r .- - <br />S:;F'. C. `. 'r P:, Y, F~In r.."? _;(?'", ~. ;:... CL ... r'A :a' ~^i'..;Y'~s .-,i~!; ... .1. ', 'li,.. ~!. ..~.., <br />_ _ 'mot <br />FtA orm 3320.1 (R 3/ ~ `~revlbus e~ itiohs`may be used. THIS IS A 4-PART FORM PAGE OF <br />