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PERMITTEE NAME/ADDRESS I/nr7udr Facilfnr.Yame/Latarion ijlAJfrrrN) NATIONAL POLLUTANT fHSCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME '.,;;?;, ~ DISCHARGE MONITORING REPORT (DMR) <br />..;~ •.- <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY r ~LriZ Z Zl~i a 1 3 1 <br />YEAR MO DAY YEAR MO DAY <br />LOCATION =~ FROM TO <br />Forrtt Approved. <br />OMB No 2040-0004 <br />~~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX ALYSIS TYPE <br /> AN <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />- MEASUREMENT '~ <br /> ' <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE ~ <br /> MEASUREMENT <br /> PERMIT ~ ~ -: -: , -_ .,, <br /> REQUIREMENT ' ,'i.ti, <br />- - SAMPLE <br />r <br />i ~~:. ~ <br />-.' MEASUREMENT <br />. <br />ti' f>t' PERMIT .. -r - , . ,. <br /> REQUIREMENT • <br /> SAMPLE ~ ~ ~ <br /> MEASUREMENT / <br /> <br /> PERMIT ~• <br />• • REQUIREMENT "' <br /> SAMPLE <br /> MEASUREMENT <br />' <br /> . <br />- .. ,. FBI, ,;.; _ , <br /> PERMIT K . <br />,. <br />~ ~ <br />~' .. r •~ <br /> REQUIREMENT <br /> SAMPLE ~ <br />I ~ `!~ - <br /> MEASUREMENT <br /> - ., .. <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE ~ ~ ~ j i - j <br />/~ <br /> MEASUREMENT <br /> - .. ~ . <br /> PERMIT ~ . - - ~. . _ .. . - <br />- <br />`' :. .. ' - . ~ . <br /> REQUIREMENT <br />ME/TITLE PRINCIPAL EXECUTIVE OFFICER I mrtih under prmdh of law that thi+dueument and all utwchnnmts werr TELEPHONE DATE <br />NA prepared umkr m~ direction or +uq+n i+ion in un•ordunre with a .y+tem dr.iGned <br /> to n~nrc that yuutifiaYl peremnrl proprrl~ Rather unA e~duatc the inku-mation -~ - ~~ <br /> wbmittrd. Baced nn mr Inyuin~ of the pervon nr prrwn+ whn munaKe the +~ atcm, ~ <br />~/ ~ " <br />--- -' " rnam direcU} responaihle for }ythrrinK the infnrmat{un, the information <br />nr those ' . <br /> p <br />l <br />- f <br />~ ~ ~ <br />/~ r _ <br />~ <br />i atr. uttd arunp <br />rtr. <br />wbmined F, to the hest of m} knuwlydPr and hr6r(. aur. acrtu SIGNATURE OF PRINCIPAL EXECUTIVE ~ - <br />% I um aware that there are .ignifirant prndUn for suhmiuinlt false infurnrrtion. <br />NT <br />ED A AREA <br /> si~dation< <br />i+u <br />ment for kmtwin <br />ihUi <br />and i <br />h <br />f r OFFICER OR AUTHORIZ <br />GE NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />g <br />e po.. <br />q o <br />inr <br />mpr <br />n <br />inchufin><t <br />COMMENTS AND EXPLANATION OF ANY VIOLAnON5 (Hererence an arracnmenrs nere~ <br />s <br />--- I~ ~• t_.~,,,,-~ {„~„1 PAGE OF <br />