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PERMITTEE NAME/ADDRESS ilnrluEr F'ariliry .VamdLrxatinn if UiJfrnnn NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />~f~X PERMIT NUMBER DISCHARGE NUMBER <br />~' ~r`~ ~ MONITORING PERIOD <br />FACILITY ~~ M , Iii I` <br />YEAR MO DAY YEAR MO DAY <br />LOCATION n~N CU f11~ FROM TO <br />-irk l~ 'J PAT"I'EI~:S~N, GIrN. M~_ <br />t .?nn Approved. <br />ph1i3 r~o 2oao•aooa <br />(: <br />F <br />FS <br />X • <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT - <br /> <br /> PERMIT " ' <br />_ <br />'• <br />,..~ 1 ~~ <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT •: c ~ :: <br />ss'r ~ - <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> . - - - - _ _ . , .~ <br /> PERMIT rc ~._, ~ , <br />, ~_,. .. r- <br /> REQUIREMENT - ~ ~'•~"`- ~ - • ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ _. - - <br /> <br />REQUIREMENT <br />~ `" ` ~ - ,t . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />/TITLE PRINCIPAL EXECUTIVE OFFICER 1 rcrtiO undrr pa•nalh of law That thi• d,a•umrnt and all auachma•nt+ wrrc - <br />~ TELEPHONE DATE <br />NAME pnparrd under nw dirntion or +ulx•ni+ion in w•a ordunar with a +~stem drsianrd ~ <br />~ <br /> <br />i eh-~rt? r .' lll i t'021 lu a+nurr that yuahfied pcrconnei prnperla tntther and a aluate Ihr informalton <br />+uhmiued. Na+ad ..n mr inyuin of the per+on or perwn whn manaar thr +}arm. - / <br />I '' <br />_ _ ~ (/ !'. ' ~ ~ <br />.`~_- <br />I- T ~G <br />` <br />~ <br />_ <br /> <br />rr+ons diredh ra.(Mm+ihk for Katherina thr infornmtion. the mfnrmatinn <br />wr Ih,nr ~ <br />- <br />"~ ? ~ C' <br />r7G < <br />~:'i~• <br /> <br />C;"i <br /> <br />lc -r <br /> <br />i <br />. <br />ide:.+ <br />re~ <br />ice p <br />- _ <br />.. <br />r <br />. <br />, nratr.and complete. <br />.uhmiuad i+, to the tw•+t of m} Lnowiedar and Iw•lief. tn,r. wt • SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that thrrc arc cian~avm prnvllir+ fur whmiuina fal+e infurmrlfon' , <br />RIZED AGENT <br />R <br />AUTH AREA <br />ER <br />YE <br />TYPED OR PRINTED including tha• puc+ihilitr of fine a,a1 impri+onment for knowing aio7atiun+• OFFICE <br />OR <br />O COD NUMB AR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I wNS (r•fererence an arracnmenrs nere~ <br /> <br />EVEti7 SUI3J~t;T TD BURBEI~ <br />itV 1 <br />Tlti~ is a 4-part ftlrln. PAGE ;OF <br />