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PERMITTEE NAMElADDRESS rlncluda r~ari/itr .'l'ame/Lornliorr if fhQerenfr NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />NAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS <br />EOX ~2E.'. PERMIT NUMBER DISCHARGE NUMBER <br />_A MONITORING PERIOD <br />FACILm I-jCli•2 i ZC7N fi 1: i•,~ <br />LOCATION YEAR MO DAY YEAR MO DAY <br />.,A GO F3I ~~ ~<~r FROM TO <br />• ; •. LP:rd!; ~ LJAI2)=, M I ~•aE MANAGER <br />Form Approved. <br />oMe No. 2oaaoooa <br />1IIJE DRr~r TP.IB TO TUTTL.~ pR <br />--~-__' <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION ND• FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s .. .. f=SEPi f•: - ~.~P{=i~? <br />. ,- <br />- REQUIREMENT i 3VDi-- :>,`~~ ~ UrtIL'' :_ .-;~;!.: ; '- <br /> SAMPLE <br />r MEASUREMENT <br /> PERMIT _ ., :~ - ,- - t? ~ ° uF~ , <br /> REQUIREMENT , • ~.' G L;r ~ i -_ .T `• `- <br /> SAMPLE I <br /> MEASUREMENT <br />,` _ PERMIT ~ ~ ;z-- ~- :; ; r7 g s , . h <br /> REQUIREMENT ~_'•~~iif~ - <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 /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrtif> under penalty nrmw that thi+daKUment ynd vU uuxhment+»em TELEPHONE <br />av+t+ion fn accordance a+i[h a 5 <br />rt <br />>ured under m <br />direction or w <br />+lem drsYgneA DATE <br /> p <br />y <br />~ <br />p <br />~ __.-,_ , <br />) <br /> <br />--- to assure that qualified personnel prnperl~ gathrr and e+uluate the information <br />~ <br />-~ f- <br />~._. _ _ +uhmia d. Ra+rA un my inquire of the prrvm or perwm ehn manage the .ysum. _~ i <br />or th,nt persam+dimtl~ ropmtible fw gathering thr infnrmatlort. the information ~ - - -' ~ / ~ _ - _~ _ ~ ~ <br />a <br />~ - Nthmithd i+. to the heri of m) Anowledge and belief, trvr. accurate, and complete. <br />~ JfJ ~' <br />4 ~ <br />I <br />NAT <br />E <br />F P <br />I <br />I <br />L <br />X <br />- <br /> $ <br />UR <br />NC <br />PA <br />ECUTIVE <br />~ <br />G <br />O <br />R <br />E <br />1 am aw arc that there ore aigniftevm prnd[ic+for .w.,,,a~~„~ rune inL,rm~ii•'o' <br /> <br />TYPED OR PRINTED AREA <br />ina9tafingthelxnsihillh,dfioeandimpri>onmrnttnr6m~„w,,l~detlon.. OFFICER OR AUTHORIZED AGENT D NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aJl attachments here) <br />~ F4 ~:;~ ~ir~_t +R2v ! jdi Pr:,::.,,: ..,~ i = _, rhl~ l~ .t -i I);Ift S(7111i rf+t~t yr <br />