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Form Approved. <br />PERMITTEE NAME/ADDRESS:(nrluilr fncifuy \un++'(A+rur.:•r :; U:; lrrru+. NATIONAL POLLUTANT DISCHARuE 'c LIMINATION SYSTEbt ((NPDE$) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (OMR) , <br />NAME <br />. ,~~I/,-. , , . <br />ADDRESS 't ~ ' ' F MN <br />,• ~~~ •c'.~ PERMIT NUMBER DISCHARGE NUMBER - FINAL <br />`yG TG TUTTLir DRAW <br />JCLA MONITORING PERIOD <br />FACILITY . = w HC?R T ZCty M I t ~ ~ YEAR MO DAY YEAR MO DAY <br />LOCATION ~; FROM •~` <br />:(:LA - TO NOTE: Read Instructions before completing this form. <br /> NO. FREQUENCY SAMPLE <br /> QUANTITY OR LOADING QUALITY OR CONCENTRATION of TYPE <br />PARAMETER EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ <br />S <br /> MEASUREMENT <br /> <br />~i <br />+~t i <br /> <br />4~F~~ T <br />f r.. <br />;v~.,_ • -~ _- <br /> <br />~-~+ . <br /> ~Y.,_x~. <br />~ - <br />~ <br />- PERMIT ; , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT - <br /> <br /> I ~~ z <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT <br />P!7 <br />_ • , <br /> # :• ~ .:: x ~~ <br /> PERMIT .. :v. . t Y <br />Jr-~ ~ `Y hiX <br /> REQUIREMENT <br /> SAMPLE <br />' MEASUREMENT <br /> PERMIT ... ... ... , .:_. <br />:3CDA A'JG <br />'r h1:~( <br />DA I L <br /> REQUIREMENT . <br /> <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT I <br /> TELEPHONE DATE <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER t crrtifi under penulh or taw that this document and au attachment. warn <br />preparrd under m~ direction .x supen-ision in accordara~e with u s~aem designed _-. <br />--~ -_. <br />- + <br />~ <br /> l.. a.wre that yuali(sd pers+mnrl pruperh gulher and e. aluale the inforntation ~ ~ <br />~ <br />--- --- - - - submitted. Based on mr imtuin of We pcr.on or prrs+ms who munaga thr s7 stem. <br />the inH+rtoaUon <br />the inrormation <br />th <br />ri / , , - <br />.~- <br />1 - <br />~J <br />! ~- ~ <br />__ _ ~ , <br />ng <br />e <br />nr lhox perv+m directly rcspmsiblr roc ga <br />true. accurate. and vmpkte. <br />. I.nowlcdgc and helkf <br />t +d <br />th <br />b _ <br /> <br />F PRINCIPAL E%ECUTIVE <br />RE <br />-~ ~ <br />'~ <br />'~ , <br />~- . <br />e <br />m <br />submitted r. to <br />e <br />tion <br />k <br />i <br />f <br />m <br />i <br />i <br />r O <br />SIGNATU AREA <br />L <br />- ~ . <br />n <br />or <br />a <br />tt <br />ng <br />a <br />e <br />1 amrwarr that Iharc are signifrcaut penalties fnr subm OFFICER OR AUTHORIZED AGENT E NUMBER YEAR MQ DAY <br />TYPED OR PRINfiED including the pwsibilih ur fine and impriconmetn for Iem+wing siolatioas. <br />_`__~~......tt ..H....s....nnro hniul <br />COMMENTS AND EXPLANAIwn ur ArvT VIVLMIIVI7J Inc.mwn.c a,. a..~ <br />EPA .•rn ==L•:) R.•. . .. 1=.. ... ., i <br />001 <br />