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PERMITTEE NAME/ADDRESS pnclude Fac7irv Name/Gocafion iJDiperenq <br />NAME d~.~ `J~J iS!r ~ ~°., ~.~.-. <br />FACILITY <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSTEM (NPDFS) <br />DISCHARGE MONITORING REPORT (DMR) <br />- ~, .,-. ~,• •~,.I- <br />PERMITNUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~! ] v' ! TO ~J 1 ' i 91 <br />Form Approved. <br />OMB No. 2040-0004 <br />' I ~I ) <br />( '.'1 <br />- ,AL <br />NOTE: Read Instructions beforeZ'iSFripleling this form. <br /> <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREODENC SAMPLE <br /> EX OF TYPE <br />PARAMETER rsfs <br />~'a <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS - <br /> SAMPLE .::: ': :•C: :: ~ ^t~) q+: {:; , .; .. .. ....:. .., <br />y ~ ~ •, _. „ MEASUREMENT <br />s.J-.~ 1 ., PERMIT 4tr#,1t_tt3 y =":=; +'t Rl'?dtpid ~4 P>~rfi :ty#3wrk ">x .:.. ,_ (~.;~,~ ..IS~1~:1{G <br />.'. r'F:. :; t~r. I' ~ ) 1, ': 4.. ~;' REQUIREMENT ~ ~ IN§fi i4lIX a"i-~ . <br />,-~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~. 'd~^ -` '" ~. <br /> REQUIREMENT - 't - ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~ _ ~ ~ - <br /> REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT- ~ - - - ~ - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> REQUIREMENT - - <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I C¢rury untler penalry of law That Nis tlocument entl all attachments were <br />i <br />h <br />t <br />d <br />tl <br />i <br />d TELEPHONE DATE <br />,-/ / I <br />( (~/~ (.~.2 /^S 7e~7` <br />'` ance w <br />a rys <br />em <br />es <br />preparetl under my tlireciion or supernsion in accor <br />t <br />gne <br />to assure mat Quelifed personnel properly gather end evaluate the inlama0on i <br />~ submiltetl. Based on my inouiry of the person or persons who manage the system, <br />' <br />- the information <br />or Nose persons direnly responsible Nr gathering Ne inlonnatlon <br />`- , : ~,. ~ ;.4G , <br />submihetl is, to the best of my knowletlge entl belies, true, azcurele, entl wmplata. SIGNATURE OF PRINCIPAL EXECUTIVE ~~~) (v~5 ~~ - ~/. [~{ Z~ <br /> <br />TYPED O PRINTED I am aware that there ere significan penalh¢s for submitting false intorrretion, <br />inclutlin the ossibili of fn¢ end Im risonment for knowin violations. OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all adachmenfs here) <br />r;~ :O°A1, Lf: )~ Llt'I .- Li. ,. is , .I `I I:. .'.'L.:4'-. JLi'_ LI :1'~ nc:'?.. .., :~ !-_~•r~ ~ - <br />r l',? <br />.. ': `' 1.. .1, p;. :, Fl,r ~', .. :!i n$81 :: s<':_. lC(. ;n~,. t:o._'^_.-.ic°: i. i. i. ~, ~~" VII. .I`L( -.!"L, <br />PA ~orm'3~320=1 (R 3~9~)~ ~rev(ous eiiilions may be used. THIS IS A 4-PART FORM PAGE OF <br />