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PERMITTEE NAME/ADDRESS Ilnrlrtde Faiilit~ \mru l.~! ^!mu ri pry), r,vr; NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY Y AR MO DAY <br />FROM TO <br />f'1. <br />rc <br />I1~Ji_~ s`}. 1 <br />Form Approved. <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION ND, FREOUENCV <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> ~'.'~"") ~~ <br />~ ~ I~~ 1t.1SIT~.1 <br /> MEASUREMENT , <br /> PERMIT .~; x ..~. <br /> REQUIREMENT ;-=. '.: 1-ii r. i'ii ;1.. <br /> SAMPLE ,\ ~_ <br />-' 1 ~ - <br />~ <br />~ L ~ - <br />~' _, <br />~I <br /> MEASUREMENT <br /> PERMIT ~. <br /> REQUIREMENT <br /> SAMPLE , <br />~` ` <br />~ ~`~' I ~f <br />'~" ~ ~ <br />~ /" <br /> <br />~~ <br />~~ ~~ <br /> MEASUREMENT <br /> PERMIT ~ . <br /> REQUIREMENT - `~ <br /> ~• ~ ~~ ! ' X'` 2/ ~ ~~B <br /> MEASUREMENT - <br /> PERMIT ,'_,. _ . _ <br /> REOUIREMENT -- - ~ ` <br /> ~' L- ~' `' ~' ~/~ <br />~ L~~~ <br /> MEASUREMENT - <br /> PERMIT - -, ; a..,. r •- • _ ! r ~./ ~. ~ . - :. ! <br /> REQUIREMENT '~'•= ' <br /> ~ i ~-' 2~- G' ~ Za" „" I ~~' 1f--15-t~W <br /> MEA UREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE ~ /y, <br />}}~~--~~ 1 f~ ~t~.~i <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ . <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certih under Iwnalp art."` that this A.ruma•m anA au attnehments wrre <br />h <br />d <br />l ~i TELEPHONE DATE <br />_ <br />~ n .~.iem <br />r~rytna <br />prrparrA unJa•r ma Airectnm ~x wpa•ni.ion in n<curA:mce wit _ _ _ <br />~~- ~ > -~-( <br />~. <br />~~ <br />~ to nswrc that ualifiad i nnel r t riy ~thrr and rs uluote Ibe information - <br />- T <br />-'k <br />.. <br />.~ <br />- <br />_ suhmittad. BxscA nn my inyuin of the Ix•rs.rn nr Ix•r«ms who ntana~e thr sy arm. ~ <br />-_- <br />- <br />~ <br /> nr thow• perwms Ain•atly rrspmsible for ¢utherlnK the information, the Informntirwt _ <br />-'-- ~~ - - <br />~ - <br />^~ <br />\ ~ _ _ _ <br />V • L ~ whmilted iv, to IM• bea of nn IcnnNh`At;C a11A Ik•Ilef. Irur. al'rnfale. amI t'.Nlrplele. <br /> <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE _ <br />• ~."-~ . ~'~ ~, <br />~ ! <br />~ <br />I ~' \ r <br />•? ~- <br /> l am aware that them ure,icni0cant penalties for wbmiuinK r:tlsr informat <br />on. QFFICER OR AUTH <br />IZED AGENT AREA <br />TYPED OR PRINTED including the pwsihility of fine and imprisnnnw•tn fur Annwint; si.datians. OR DE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATIVN vF Arvr vwLA I wrvs IHererence an arracnmenrs nere~ <br />FPq F .: i F7ny z; F!=. .. - Ill- !~ i !- ~.il' li~flll. PAGE OF <br />