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PERMITTEE NAMEtADDRESS t/nt7trdr Fd~ilitt•:YamdfwKmien ifOifferenU <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION a ] b~~ <br />''r ~', .i*t.:' r?~C,l.F7"~F=+1"IC~~+1 i~i~idflG£f•( <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 />OMB No. 2040.0004 <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br /> 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 />r <br />~' <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I reni(~ under tx•nalh of lun Ihat 1hi+A.numa•nt atxl all atlarhtnrnl+ wa•rr <br />ad uudcr ma di <br />ntlu <br />iun in <br />r <br />w <br />ni <br />d <br />with <br />a <br />d <br />i <br />d TELEPHONE DATE <br /> pr <br />pxr <br />r <br />n or <br />yr <br />+ <br />aunr <br />unre <br />arm <br />c. <br />a . <br />ynt <br /> a. xa+urr that yuulified personnel pruperl. KullKr and eaxluula• the in(urtnaliun <br /> cuhmilud. Ru+rd on m~ inyuin nl the pennn or pa•r+am ahn manakr. thr e~.trm, <br /> nr thusr percuns dittcd~ rrslxm+ihlr fur ¢atherin~ the inWrmutl. m, the m(urtnxlinn <br /> .ubmiuad i., to thr Iw t of m. knowlcdfir xnd belief, trur. wturxte, and cumptrrr. <br />I om nuurr that thrrr xn• ai>;nifx:xnt pewltin fur whmittlrte fake in(nnnati.xt <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />_ _ 1. <br />TYPED OR PRINTED . <br />inrhxlingthrpn+ihiliq o(finrand impri+anmrnl G.r-uuwnt¢ aitdxli,gt+. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CUUE YEAR MQ DAY <br />COMMENTS AND EXPLarva I Ictrv rJr Arv Y vwLA I wrvs (He-erence an attachments here) - <br />y, ~•r.-r~ r,n ~ !^1~.rnr rc> r n ?•••7 t,r c- <br />_>-~ a. P._.>.. r 1---... - -• T!-}•J,_• T, _, "T •X "fY" r r• l Cdr.. <br />EPA Form 33201 lRev. 3/94) Previous editions may be used- Tf11s Is a -l-(Idrt f(Iftll. PAGE OF <br />