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PERMIITEE NAME/ADDRESS ilnrfude FueiluY.1'atnr/Locubnn iJUiJ/ncnu <br />NAME <br />ADDRESS - - - <br />f ;,ay <br />f, 0 t3 i 42 4 <br />FACILITY ; _ f (L ~ i~;\ f'3 i. h, T. <br />LOCATION I_ti ~i3 ~? j 42Q. <br />s r. s.:!^c: ..'r. iii ~iTRiC Mal\I~r`1-G <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 />t1 I ^d 1=. D R <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX FREDUENCY <br />OF <br />ANALYSIS SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br /> . <br /> PERMIT <br />REQUIREMENT ~ •3;- s_ u ~'. ;~ <br />~"j i+' ;.. - - ,- ,:- : - - <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 /> PEAMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />NAMEJfITLE PRINCIPAL EXECUTIVE OFFICER I crniry under pr+ndty of m~ thm tbi. d.KUncentand au attachma+t. aerr <br />prr{+ured undrr m~ direction ur eupen isi+m in wxordume ~itt+u ~atrm Jr+iytned <br />~ - TELEPHONE DATE <br /> <br />_ _ _ - __ <br />~- <br />F to ucyure that yuulifin! penot+nel proprrh guthrr and e. aluulr the Infurmutiw <br />~uhmfttrd. Ha+aVl un my inyuin of the prrsun nr per.om Mh.. manuKr the .~.trm. <br />wntihlr for gathrrink Ihr information, the Infnrrt+a8un <br />tho <br />rwne dirrdl <br />r Y ~ -. . <br />',~ j <br />1 --~---~` ~ <br /> <br />/ <br /> <br />~ <br /> <br />t / ., <br />{ ' Z <br />~~~ u pe <br />~ <br />l <br />nr <br />submillyd i<, Io Ihr 6ext of m~ k+x+wird>;e and hrlief. Irur. w-cunrte. and cum pletr. <br />SIGNATURE OF PRINCIPAL EXECUTIVE - ~ ~-'~f '~ ' ~ J <br />-' I am annre that there are.iguif+cunt pmalUer for ruhmiuin¢ fake. information, A R <br />A <br />TYPED OR PRIN D including the po..lbilitr of f+nc and imprivmmrnt for AnnwinK .loluuom. GENT <br />OFFICER OR AUTHORIZED p <br />C <br />NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />~ I It~ITT ~Pf~ <br />Civ~.~•~ h <br />