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PERMITTEE NAMElADDRESS rlnc(udr Ftrrilits.\ame/L.Karion iJUrfJoerul NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS , .. ~i.li'~ <br />~~~(r_~a[ PERMIT NUMBER DISCHARGE NUMBER <br />'_F~ <br />FACILm HCR I ZUiV i•i i ~ .:= MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />~A ~ FROM TO <br />- ~ AIVC~ ~,A~L • `; i ~`i _ i`il~S1'ti riuL ~, <br />Form Approved. <br />oMS No. 2oaaoooa <br />ll`J-: <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ } <br /> MEASUREMENT - ~ "- <br /> <br /> REQUIREMENT C?A Z LY !-''" <br /> SAMPLE <br /> MEASUREMENT - ~ - <br /> PERMIT ~ :. r r_ : ,,_ , <br /> REQUIREMENT, -. iii=~ ~ LY `°!" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - _ ~ T R EP OI' - _ - <br /> REQUIREMENT "- tJR~ I1_Y I•;:~ ' <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 penY1K of luw Ihal Ibi+dncumrnl Wnd ull alluchmrnB were <br />ti <br />with <br />t <br />d <br />s <br />di <br />~ <br />i <br />i <br />d <br />d <br />i <br />d TELEPHONE DATE <br /> cm ur wlw <br />n <br />on m ocair <br />a y+ <br />em <br />e <br />gne <br />prrpnn• <br />u <br />er m~ <br />rrc <br />+ <br />unce - <br />.---- ""~ w u+wrr Iful yu~lifird prrvmnel pn~prr{y gather and r~aluulr Ulr InfwrmulNm - - ~T- <br />~~ <br />__ submitted. Ba+ed on m+ inyuir~ ~,<Ihc prr+nn ur prrvms whu menage the eptem. - <br /> wr Ihux prt`tm+direcd) repun+ibk fur gnlhering the infwrmaUun. IfM infurmatiwn ~. .Y - <br /> .ubmined b. to the tw t u(m~ Am~wlydl;r and IKlirt. Irur. ~ccurute. and cumpkte. <br /> <br />' <br />dti <br />itti <br />t+ <br />ti <br />h <br />i <br />ifk <br />f <br />h <br />f <br />i <br />k SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br /> nm petu <br />~ <br />a <br />c <br />n <br />~rma <br />I am nwarc Ihat I <br />rre ere . <br />gn <br />ex <br />ur su <br />m <br />~m. OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED imiuding lM• p~mibllil~ of fine and impriummrm fnr km~wing +i~Auu~m+. DE NUMBER YEAR MQ DAY <br />GUnnmervla strvu ~nrLE+rvAnvrv yr rarvT VIVLHIIVIVJ (lYBre(t?IlG6 i9U rlitdG/f/rlCrltJ rICrC~ <br /> <br />