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PERMITTEE NAME/ADDRESS rlnclude F'acififi .~'amdLncarinn q htJJrrnd• <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />C? ~~ : ~. 3 <br />'tfZr'~H~ti~~ <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. 2040.000~t <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. <br /> <br />EX FREQUENCY <br /> <br />OF <br />SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />~ - <br />~ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />l <br /> MEASUREMENT I <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />~ <br />a <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE _ <br />~ <br />~ <br /> MEASUREMENT - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE r <br />-~ <br /> MEASUREMENT <br /> PERMIT ~ ~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER t aertit~ wterr penalq ..r law that thi. ducnmrnt and au alta<hmenn .a<ra' <br />J <br />i <br />d <br />i <br />d <br />h TELEPHONE DATE <br /> a yalrm <br />prepared under m~ d <br />reatiun or .open nom m a.rnr <br />unrc wrt <br />cti <br />~nr <br /> In u.aurc tlwt yualifwd per+nnnel propavh gather and ra sduute for inGrtmali.wt <br /> suhmitlad. Raaa•d .m m~ inyuin of the prnon nr per..ma who mono*c the as .Irm. <br /> or th.w• Iw•raom dirrctla ra.{wmaihl< for Kathrrinq the informutiurt. the mfnrnwtinn , <br /> wbmitt<d is m the t~l of m~ AnowlydRe and Iw•lia•f, Irae, accorutr. and complAr. <br /> <br />i <br />ti <br />h <br />if <br />l <br />i <br />f <br />h <br />i <br />i <br />f <br />l <br />f $IGNATi1RE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED ar au <br />se <br />ormu <br />ua. <br />1 am awun• That I <br />rrr are ai~n <br />icnm Iw:nu <br />t <br />a+ <br />m <br />u <br />n~ <br />a <br />n <br />imludin>; the pwaihilin of 6n< and inyviannmem Gx knoainR ci.duti.m.. OFFICER OR AUTHORIZED AGENT AREA <br />D NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EFA F~:rn', 332J-1 +Rw F r.~w~~ _::~i' - :. ..- -- I ilia I• :1 ~-I~;tI'i If:I~lll. <br />