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NAME ~~~~ <br />ADDRESS ~ ~QFZ T Z UN M I I <br />BQX' c.~8 <br />i_A <br />FACILITY Hr~f~~'Z~ty` 1"1I' <br />LOCATION ~A <br />L;Q $24Z4 <br />titin~nnco <br />RATIONAL 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 />orm Approvea <br />)M8 No. 2040-~ e_~ ,~ <br />• - F 1 N/•' ~' <br />~.-_. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />DF SAMPLE <br /> <br />EX <br />ANALYSIS TYPE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> . <br />. <br />::: <br />- , <br /> PERMIT .... ~ .. -:. ... _, ~ <br />; <br />__ ~ ::Jib T i , <br />~; L <br /> REQUIREMENT :',t gip,: -.,', r ~. •,` ~`l;: ''! <br /> SAMPLE <br /> MEASUREMENT <br /> : - <br /> PERMIT - . ; - ~ i:: <br />_ <br /> 'REQUIREMENT : ~ F)UL' llii ? ~_`f <br /> SAMPLE <br />~ <br />'~ <br />' <br />= MEASUREMENT <br />. <br />. <br />t T ~:: <br />; _ <br />- PERMIT _ <br />_ - ;~GvA t;'Ji3 t~fiTLY I•~~ ~ - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ~ .r fi ; , ~_ r.A _ .~ i=. c.: _)IZ T ,F : <br /> :+tiil?~~ ~~'~~ ` : •.i._Y :. <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 rrniq nndv penuh> ..f Inw thm thi+d:.~umcnt and all ntachment+ wrrc TELEPHONE DATE <br /> prrpur •d under m~ direction ur wix•n~i+i~m in ora•orduncr with o system de+iKnrd ~_ <br /> to nswrc that yuuliricd prrwnnd prrperlr prHMr and e+ulruur the information _ <br />_ " <br />" . - _ _ _ -_ <br />` -- +ubmittrd. liaad un m9 inyuin id the prrum or person+ w ho munnRe the s+trm. <br />onsilrlr fur Kathrring the informutirm, the information <br />ecUr re+ <br />th <br />rn <br />+di ~ ~~ f <br />~ - <br /> <br />~ _ p <br />or <br />u+a p <br />nn <br />r <br />+ubmlttad k, to for hr+t of m+ LnowiadRe and Iw~licf. true, urarrule, and cumpkte. <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE , <br />' - •~ <br />- _ <br />' ~' ' I um uwurc Ihnt thcrc are+i~nifieun pennhie+ for+uhmiuinQ Pale infurmWion. THORIZED AGENT <br />R AREA <br />MBER YEAR MO DAY <br />TYPED OR PRINTED imlruting the pu+cibility of fine oral impri~onmrnt for IJ1uwInR +iolnlion+. OFFICE <br />OR AU NU <br />OD <br />COMMEN T S ANU tAYLAIVA 11V1V Vr Mtn r vwa_r: t rvna Incrcrcna.c on o..a+....,.._...,~ .......~ <br />ilnciudr FaciGfr.tiumrlGxufinn if Utffcrrnt, <br />~~ i; ' <br />PAGE Uf <br />cw _ .. . _. <br />