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PERMITTEE NAME/ADDRESS Nntlude t'ariGtr Some/laruliun ij(hjjerrnf <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />r~a,~va~>^ I:t <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 />Form Approved. <br />QMB No. 2040.0004' <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - <br /> MEASUREMENT ~ <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I itrtih under prnalt. of law Ihxl Ihis d~wvmcm and all attaehments were <br />r <br />r <br />d <br />t <br />d <br />di <br />i <br />i <br />h <br />d TELEPHONE DATE <br /> pr <br />p <br />re <br />un <br />rr m) <br />mn ..r +upa•n <br />rrc <br />+ <br />un <br />: :wror <br />anec xith a+}shm de.igncA <br /> In n~aun• lhal ymliMd q•nnnnel proprri~ gathrr and e, uluatr the infornmlian r <br /> .uhmillyd. ff~ed :ul m} inyuin of the pr n„n ..r (rer+..n. w hu manugr the +.+H~nl, <br /> or Iho+e prnon. dirrrll) recgrncihlr for guthvring thr mfnrmatunt. Ihr informati~.n <br /> wbmiued is, m Ihr ba•H.d m. knowledge ;md Iw•lief. tn:e.:u~runtr• and compirta <br /> <br />I am ww are lhul Ihere are signifn ©nt <br />en-aloe. h:r .ubmillin <br />f <br />tur <br />atin <br />l <br />~ i SIGNATURE OF PRINCIPAL EXECUTIVE <br />` ' <br />TYPED OR PRINTED p <br />g <br />a <br />x <br />n <br />m <br />n. <br />hKluding the lwr.ihilit~ of fine and imprivnunent fnr knowing+Hdatinn,, OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MQ DAY <br /> CODE <br />GUMMtrv15 ANU tAYLArvAI1Vrv Vr ArvT VIVLAIIVIVJ Irreverence au arracnmenrs Here) <br />O z ~ This i. a ~-Dart Firm. <br />