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PERMITTEE NAME/ADDRESS r/ntfudr Fa•i/in' ~auur/l.~ration if Uiffrrrrttl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />;:',Z £~ 1 ~, ;' S <br />^N ~J~ny~'-~i~ <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 />,j" <br />NOTE: Read Instructions befol`e completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX AN <br />IS TYPE <br /> ALYS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I arrllr. undrr pen:dlc of Iww Ihw Ihic daKUmenl and +11 atwrhmrN. werr TELEPHONE DATE <br /> prrparad umlrr m~ direction or .II(n•n i.inn in accord~ana with u .~.Irm Aa+iYnrd <br /> lip A~411rY lllal tlnnhrled prMMnrl prwprrl\ gnlher ~11d a\a111Y1C Ihr Ilir~~rnlanun <br /> .uhmiOrd. Hawd on mr inquire nr Ihr prnon ur Iw•nlma aho nwnaEe Ihr .a.Irm. <br />nr thuw• prnom dinstla nrpm.ihle fur guthrring the information, Ihr information <br /> l <br />l <br />tr <br />f <br /> , Ina•, accurate, mu <br />cnmp <br />r <br />_ <br />.uhmiurd iY. to Ihr hr.t of mr Ano.drdgr »nd hrlir SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I rem awurr that there urr >ignit;wm IK•naltiea free cubmilting falra• informetiu°' <br />T AREA <br /> risonment for IJU~wlllg ai~datiun>. <br />oseihilit <br />of firer and im <br />i <br />ludin <br />Ihr OFFICER OR AUTHORIZED AGEN DE NUMBER YEAR MQ OAY <br />TYPED OR PRINTED ~ <br />p <br />nc <br />g <br />p <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments Here) <br />.~.,~, 1-1t"tf'r ~t~P'_ ff.;' FfJF/ =~(tiYP„ ~-~lFif-' p{?~r: IP f.=V~l~iT; _(~'.~~ <br />FPA F.;r~ 3320-. iRev. 395r Prevrous e..'.•~on< T~ ... _ Tht~ i~. ;I 1-I~;U~1 I~rartp. PAGE OF <br />