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PERMITTEE NAMElADDRESS Unrlude Facility ~mne/laafiun if DiffrreNi NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />"- PERMIT NUMBER DISCHARGE NUMBER <br />FACtLmr ,~ ,. i !E MONITORING PERIOD <br />LOCATION --.~~,{ ,_ h ~rJ-;~:• YEAR MO DAY YEAR MO DAY <br />FROM TO <br />•i~Gf-: '•! PATTFftSQN: GEN. M+ <br />a.pproJl: i <br />5'or~D >: ''t='.IL Ta GANAtJIfi!''• F?IVF_R <br />Y <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :~ •~ r .. • .,z - _ _:. ... , <br /> REQUIREMENT ~ ~ , ^~~tX IMt!M i ~t'i,; fl-I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :: ">:-,..: :; <br /> <br />REQUIREMENT rA Y ... + r i-I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;, ~, _ .., <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />-' ., . r i <br /> REQUIREMENT '' 'r~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT v .., <br /> REQUIREMENT :-, ~ . ~ ~, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I eerlih under pemlry of la» Thal thl. d~wumamt and uu wtachmem. »ere <br />~ - --- -~ TELEPHONE DATE <br /> c with n c),trm dnixnrd <br />prepared under m. dirertlon or wpl•r. i.iun in aanrdam 1 <br />f,.~ <br />~~ i G,h ~,~ - s ~ "'01"' to asure tlmt yualiRed perwnnd proprrty KJlher and C\alUJle Ihr Infllrmatllln ~_ /' ~ 1• , <br />' <br /> submiuld. Rncrd un m. inyuin of the Imrem ar {nr+»n. »ha menxCr the .~+u•n4 / • ~ ~ ~ <br />r'~...~ <br />~ ~ <br />' ~~ r-~ - _ <br /> <br />` ~ <br />C (• _ 1 /' ^ ,~ -~ c• • ; '., <br />- or Ih~.»• perwml directly re.pmeiMe far ~atherinR the information, thr inrurmntinn ~' <br />. ~ <br />ri r'O ,'' <br />, <br />~! ~ <br />~ ^^ <br />~ <br />~ <br />- d, the t»•ct n( m <br />kno»led <br />e and betlef <br />In/e <br />accurnle <br />and rnm <br />letr <br />h <br />ttt <br />d ic ~ ~ <br />- <br />~ <br />' ll • ^ ? T <br /> p <br />. <br />, <br />. <br />p <br />. <br />xu <br />m <br />e <br />, <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED I am a»are that tM•re arc rignificmu pcnaftili for.uhmittink fnhx infarmou~,n. <br />IrKhdingthe pintiibilih ..f fine and inq.ri•~mmmt tar kn..»in~ ciolutiam. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />O YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments nereJ <br />IIT1~ 1~ ;t ti-~~;!fI i!~f ill. <br />EPA Form ~3:'ti~t iRev, 3 `?9, Pr~..~,~,s s_,~.~~r~ .__ ~ PAGE OF <br />