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PERMITTEE NAME/ADDRESS ilnrladr F'ariGtr,Vamrl/.acarion ifUrJJrrrnfl <br />NAME _ ~,i,iu, i_LC <br />ADDRESS _ ~t~.:dr. <br />~i~x ~~8 , <br />~r-~ ~. C€'~a~614z4 <br />FACIUTV HpR i ZC7nt ~ i r~~ <br />LOCATION _a C.Q ~ j 42.4 <br />: ~.s.tr~ unr.>` MT:.I'G Mp~S~(`FR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />orm Approved <br />>MB No. 2f140- <br />~~ i]~;\t; ~•i <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER r <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />ND, <br /> <br />EX <br />FREQUENCY <br />OF <br />ANALYSIS <br />SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />- SAMPLE <br />fuIEASUREMENT <br />^' .' <br />'"- ~ ~_.. ~ /: _ <br />- <br /> I n <br />~ <br /> PERMIT I is <br />REQUIREMENT <br />SAMPLE r ^.fi :c~ ~ F?>~j-~r'~'; i <br />SODA Fi'~,.; <br />/ REf~..,R <br />t'R i L_". ~ i i'. <br />~ ~ <br /> <br />~% <br />~'i - - - <br /> MEASUREMENT <br /> <br /> <br /> <br />- <br />- PERMIT >s <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT .- - <br />3UL'.~: .y'vi~ <br />-_ ;3 F_?;lf? <br />uriZLY - <br />"~ <br /> <br />~ <br />~'' ~'= i ` <br /> <br />- <br />' .if-tL~ , <br />ly <br />- <br />- PERMIT ;~ <br />REQUIREMENT - - .-=~'=" - ftFf't=tftT <br />-- REPC3RT <br />_ ''.:I- `." .-?:: <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br /> <br />- _ -- - I r"~'n,P under prnulq ..f law that tht+dorutnrm and all atwchment+wrrr <br />prepared under nq dinction nr wprrri+ion in nccurdance with a .~ aum de+igard <br />to a++urc that yualllkd prnrmm~l pngrcrh gather and r+aluale the information <br />+ulwttilted. 6a«d on m) inquiry :>( the prrwn or penon+ who monagr the +c+trm. <br />un+iMr fur gathrrinR the informati,m, for information <br />; dircrtl <br />th <br />r <br />rc+ _ <br />- <br />, • , TELEPHONE DATE <br /> y <br />p <br />uv pr <br />+r.n <br />ur <br />.uhmittrdn, a, the ta_~ct of m) knowledge and belief. true. nrurvta and a,mpkte. SIGNATURE OF PRINCIPAL EXECUTIVE , ' <br /> <br />TYPED OR PRINTED I am aware that three are +ignifiarm penahir+ for +ubmitting fal+r infurmulioa. <br />including lbr pm+ihility of fine aril impriwnment for knowing +iolatioro. OFFICER OR AUTHORIZED AGENT AREA <br />DE NUMBER <br />YEAR <br />MQ <br />DAY <br /> <br /> <br /> <br /> <br /> <br />MMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all <br />here) <br />_~ i . PAGE OF <br />Tflis is `~ 4-paE #orm. <br />s F.: - - <br />