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PERMITTEE NAMElADDRESS tlncludr faciGtr Vamdl~ruriun rflliffrrenU <br />NAME <br />ADDRESS .. <br />IjO~ti X23 <br />FACILITY ~-j~F j ;-i.~i'V ('Illti.i_ <br />LOCATION _f1 iJ•Q ~I <br />i_AAIC~ WADE, NE~fIVF MCaft1AC'-EF <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 />Forth Approved. <br />OMB No. 2040-0004 <br />Sk°•~ir?ii`li GRNc~ TEJ TUT? <br />,X <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREDUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ra-•~;~• f~EP17RT P R - _ ':• ~ ~r% <br /> flEQUIREMENT ~';JA. AVG DAILY :'(~ ' '• MEJRIT! <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~~ :: ~; ~ ~i a ~, c , E" 1+" R EP QR i - <br /> REQUIREMENT ; :"pry A'; ; : ^~ I i_ 4' , ^,f, <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT is ##~z-t•iF , . T ~ I ( . r .n <br />. REQUIREMENT - AVG DAILY f iX ~. ` <br /> SAMPLE <br /> MEASUREMENT <br />. PERMIT - -: x-t•~-# ,. .. ? ~ , <br /> REQUIREMENT 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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ ,rrlir. under prnaly onaw that mi. documem and au utlal'hmenb were <br />d <br />• <br />i <br />id <br />I <br />d <br />i <br />h <br />d <br />f <br />d <br />- -~ TELEPHONE DATE <br /> n accor <br />prrparrd un <br />er m~ direa <br />on or .upen <br />on <br />ance w <br />t <br />u warm <br />n <br />rtne <br />t _ <br />J <br />_~ to inure Ihm yuallfird prrvmnel properly Rathrr and ecaluutr the information <br />__ ~ athmittcd. Ka ed wt my itpuin of the perwn ur per~tat. wM, manalte th< raaem. <br />~ <br /> or lh~na prrtim~ dined. roponcihlr for ¢athrrinq thr in(nrmaton, thr information ~ ,r - , <br />/ wbmillyd i. <br />to the hr+l of my knowledKr and belief <br />true <br />accurate <br />and cumplrtr. ~ - - / • / ` ` i <br />~ <br /> . <br />. <br />. <br />, SIGNATURE OF PRINCIPAL EXECUTIVE _ <br />TYPED PRINTED 1 am aware that (here urr.iynfir+m prnahie. L.r ,ubmlumc ral.c inG~rmalL~n. <br />itrctnding thr p~..ibility ,d 6ne and imprl.oum,m h•t 6nowing ~ hdatim~,. OFFICER OR AUTHORRED AGENT CRpA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY vIVLA l wlvs (rrererence af( anacnmenrs neref <br />EPA Forth 3320-1 IRev 3+'991 Previous edltlons may be used <br />