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PERMIITEE NAMElADDRESS ~lnrludr Farilitr ,~amr/Lnrnrion if IJiffacnrl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMR NUMBER DISCHARGE NUMBER <br />FACILITY ~ ; ~ idE MONITORING PERIOD <br />LOCATION ~ EN C U f~Or=: FROM YEAR MO DAY TO Y AR MO DAY <br />"1 htG:F V PATTF.RSON. GFN. I"C <br />(-•mi P.pprovP~ <br />r_;L18 No ?OaO OrRd <br />NOTE: Read Instructions before completing this form. <br />5N I, <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br /> <br />DF <br />SAMPLE <br /> EX <br />YS <br />S TYPE <br /> I <br />ANAL <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - . r. t,- ~ ,.. ,. - .~ ,. . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s _ .~ - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. ,. ,. ~ „ ;r ;c . ,. - <br /> REQUIREMENT <br /> SAMPLE <br />, MEASUREMENT <br /> .... ._ - - <br />... _ - ,. ~_ . <br />.. PERMIT I <br />- -"~~ _ <br />, .., <br /> REQUIREMENT ~._ ~ L:' /:. r'~',1 ~:, ~'i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , ; _ .: y. - ., .. .. ., . -_ .., <br />` ~ [-:-- <br /> REQUIREMENT i ~,,` _, - fiC7i <br />iTH <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certif. Ilndrr IRnidl\ Ur LPN [hut (1115 d1A'IIIIMnI'wntl 1111 mwchmenls Nrrr <br />~ TELEPHONE DATE <br /> <br />T <br />' prepared under nq direction ..r wlxni5ion in asrordonre with r 5)s irm de5i);ned - <br />athrr and r[ aluate Ihr information ( <br />.n <br />erl <br />lified <br />l <br />rr <br />Ih <br />l i ~ y j <br />,/ <br />f <br />~ ~ ., .7 ; <br />~ ~~ <br />- per <br />p <br />~ P <br />to u5wrc <br />a <br />qua <br />nce <br />p ~ <br />~ <br />~1 <br /> <br />~ ± <br />C @ 1"r' t - 1' ~ ~" suhmitlyd. iia5rd on m? inyuin of the pervon or pcr5ons Nha mnnngr the .~ 5trm, <br />or thou (x r5on. <lirtsily rr5ptmiMe GK gatherinK the informrtion. the inlormation J <br />• <br />~ <br />~-- - <br />be-4 <br />'-~"(~ ~- "~~ j1 ;~ ~~~. <br />(;'~ <br />l r~ <br />^ ~ <br />. <br />• suhmitleA i•, to the hest of m5 15noN1edAc and hrlkF, tnn•, anvrutc. and complete' ~ ~ SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I um aNarc thin there are 5igniriran[ penalties for submittirtR false Information' AREA <br /> t Gir Anawink 5iolations <br />ihili <br />f fine m <br />i i <br />iu <br />i <br />l <br />di <br />th OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />e po55 <br />ry o <br />a <br />mpr <br />mmm <br />nr <br />u <br />nyt ODE <br />COMQIIENTS AND EXF'LANAIIUn Ut ArvT VIVLNIItJrvJ (nrrrrrncr an aunwnnrrna nC/C/ <br /> <br />