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PERMITTEE NAME/ADDRESS rlnrludr Pacilitj :YomdGxapon ijDiJjrrenfi NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME ; ;+ DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS - -• <br />~;'= '.'~- ~ BClFt Q I-i I ~ ~ - = PERMIT NUMBER DISCHARGE NUMBER <br />iI' A AL.L_S <br />FACILITY -: Qr; _I;_;-;;_ T I t]I`; F7I L,iF MONITORING PERIOD <br />LOCATION •.1~; :, YEAR MO DAY YEAR MO DAY <br />~- ~` FROM TO <br />F - F I f~i s1 L <br />SI-QI F3~fyv <br />OhiG Id.~ .: i~'J U'~ ~.. <br />~. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ r, _ >.. ,. .. _. <br /> REQUIREMENT - .~ : ~.; i ; ;, . , n; ~ ; ~ <br /> SAMPLE ~ <br /> MEASUREMENT <br /> PERMIT ~s ~#- :r :: _ , . ._, <br /> REQUIREMENT • <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - ~.t :,- .~ • <br /> REQUIREMENT ~ • ~ •' '. <br /> <br /> SAMPLE ~ ~'~ ~ <br />- <br /> <br />MEASUREMENT <br />~~ ~ <br />_ <br />i <br /> PERMIT .:~ r ; ~ .. , - :~ _: ,-,. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ~~~~ <br /> PERMIT -, ~ ..~ .~ ~. - :. __, r ._ ~ <br /> REQUIREMENT <br /> SAMPLE / <br /> MEASUREMENT <br /> PERMIT •;:.,. ... , ,_ - <br /> REQUIREMENT .`->T ~ ~ ; <br /> SAMPLE ~' <br /> MEASUREMENT <br />I <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rrrtir~ raider pemul ref h:N that this d«umrnt and uli:dtxrhmrnb werr <br />dirca•6nn ..r su <br />ra irinn in wr..nlxmr with a s <br />rr <br />arrd undrr m <br />strm drsi <br />tted ~ ~ <br />~ ~. TELEPHONE DATE <br />Y I~• l - ~ <br />~ - v ~~ <br />~ ' ~- L p <br />p <br />~ <br />p <br />~ <br />Q <br />lu <br />~ urr Ihul <br />difird <br />ers <br />ro <br />rrl <br />a111t•r and e~aluutr tite infarmatiim <br />u <br />l <br />~ / <br />~ '• <br />_ <br />. <br />- p <br />. <br />p <br />~ <br />y <br />a <br />gw <br />uK <br />p ~ <br />s. <br />f~ <br />~ <br />` _.1` ~ ~ 1 !' l suhmitnd. Nusavf on m~ Inquire of thr lx•rs+rn ..r perum whu manage thr +. stem, / ~~~~ - <br />~ <br />, <br />_ _ _ <br />- <br />~ ur lh~nr pawn+dirartly Rti1M ~n.ihlr h.r ¢uthrrinl; Ihr lnlurnwU~.n. the lnformnllun J.' <br />~ --_ __ a ~'fA ~ J <br />1 `V <br />C l <br />O / ~, <br />I <br />~ <br />~ <br />I I <br />- <br />'/a <br />r <br />~; <br />< ' ! <br />~ <br />submitted is <br />to the hest of m~ Anuwiadge and heltef. true, auurute <br />and compkla <br />/ f ..• ~ 1 <br />~~~ ~ ~. \I , <br />-y <br />` <br />I <br />` <br />~ <br />_ _ , <br />. <br />itti <br />1 u <br />uH <br />Th <br />t Ih <br />r <br />+~ <br />~c <br />l <br />nuhi <br />~ fn <br />uh <br />falw i <br />for <br />ll SIGNATURE OF PRINCI AL EXECUTIVE ~ <br /> <br />TYPED OR PRINTED m <br />art <br />a <br />e are <br />yn <br />an <br />pe <br />a <br />r . <br />m <br />ng <br />n <br />ma <br />nn. <br />r <br />inaludingthe p:ssihilit~ of tint and impris.mmrm fnr kru:wing riolatlurts. <br />OFFICER OR AUTHdRIZED AGENT <br />AREA NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXrL.Arva I wrv yr wrv Y vwL.A I Iurv~ fHererence an atracnmenrs Here/ <br />~::EIN EVENT <br />I ft I~MFNTS <br />EPA Form 3 zp-t (Rev. 3!991 Previous editions may be used T}ttti 13 ~ ~-pari IOrm. PAGE OF <br />