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PERMITTEE NAMElADDRESS tlnrludr Farid7r A'amrQncrrrion ijDifjrrtrttJ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ' '-"` - <br />r; ~ :; PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY ? Z~;f~; , <br />YEAR MO DAY YEAR M DAY <br />LOCATION C ~~ ! FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br /> <br />.- <br />--~ <br />NOTE: Read Instructions before completing this form. <br />RAMETER <br />P QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO, FREQUENCY <br />OF <br />SAMPLE <br />A EX ANALYSIS TYPE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ` "r " <br />' REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT .. .. ~ .: •r: <br />'~' _ . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> • <br /> PERMIT fi :_r,._, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> = <br /> <br />' PERMIT - - .:~ - r _; <br />" <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT f;1~;-; ,;i <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />~ ~ ` - . .... - .... <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I `crul~ under prnuln o! law that this d«umrm and WI attnrhmcnt,were TELEPHONE DATE <br /> prepared under my dimtiun or wprn-i+iun in accurrlance with u gslem daiKnrd <br /> tw uwrc that ytmlifird personnel pruperiy Kalhcr and evaluate the inforntadoo -- _ ~---- ` r <br />_ __ _._ - _ , whmittrd. Hard on mr inquiry of the prrwn ur perw,ns who mana(tr the system. <br />the information <br />atherin>: the information <br />onsible fur <br />th <br />+ <br />h <br />di 1 _ - , i <br />- <br />~ ~-- - , <br />p <br />R <br />rrc <br />re <br />ur t <br />~nr la:ntxi+ <br />~ ~' ~ ~ : <br />r' <br />/- <br />~' _ <br />,~ submitted is, to the hest of ms hm~wlydRe and la•licf, true, attuntc. and cnmpklr. SIGNATURE OF PRINCIPAL EXECUTIVE . <br />- <br />'~ - C ~ <br />` I am aware that there are ciRnificant prnaltie. for +uhmitting false information. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED QR PRINTED.' includin>: the puvsiMlity ..! rme and imprkonment fur Gnow ing siolation.. E <br />COMMENTS AND EXPLANATION Ur ANY vIULAII~rva Irreterenrt: nn auacrrrrrcrrta r,cr c/ <br />',~ LIMIT APrJ± I EU E7R IOYf2/c4HR PREC I P EVENT - 5F_E I . A. 2r <br />• •~ -- I ~~ ,.-~- <br />Thi< i~ a -~-t~a>-t ft~rm. PAGE OF <br />- ~r __ ,. . <br />