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PERMITTEE NAME/ADDRESS ilnrlud~ £ruiUty ,Karne/lnratiun iJ1AjJrrratl <br />NAME L.._ •_ <br />ADDRESS ~ - ~ l '' <br />Y i..E;`T I'~µZiv STRc~T <br />;il.~~, ~G Ir:CB~ <br />FACILITY "~~:.,'i Tr L,Hi'~!YC;~ {'~I I'dE <br />LOCATION i3`.i C~ Q Q ] tj9 1 <br />~. ::=IDi"a~TOh;, MIP~F MAI`~t~C-Ei3 <br />} <br />PERMIT NUMBER DISCHARGE NUMB[:' <br />MONITORING PERIOD <br />Y AR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />`1 I f <br />_ - FIitii~l_ ~k' <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 . , .. , ,. _ <br /> REQUIREMENT ; i. !~ ~.-';f ,. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,... ;. ~ .~ .. ,~ - . . __ <br /> <br />REQUIREMENT ,., <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , . ,. _ <br /> REQUIREMENT J ' <br /> SAMPLE ~ y <br /> MEASUREMENT ~ ~ ~~' i •` <br /> PERMIT ~, ., - _, _ ~ , ,.. <br /> REQUIREMENT ~ <br />~l ='/ F;'. _ ~ i ~i ~ . <br /> SAMPLE ~ / <br /> MEASUREMENT <br /> PERMIT -- ~ ~ J ; <br /> REQUIREMENT ~ t''tJ~f i f-i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ ~ ,., <br />, - - <br />~ ._ <br /> REQUIREMENT ~.,,c:. I <br />,' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _- _ ,. .... .. ., .. , <br /> REQUIREMENT '-!, • A'~~ I__ `~ :" <br />NAMElfITLEPRINCIPALEXECUTIVEOFFICER i,a•~tii"mdrrpennlhurlnwthatthi.d,,.umrntandullalhxhmmt+wcre <br />urrA undrr m. dirrrtinn nr .u <br />•nision in ru nrvhmcr with a <br />.lrm deai¢ned <br />re / <br />// TELEPHONE DATE <br />w~Q ~./ J (~~ _ ,_ / r' ~' ~ %' i - - - p <br />q <br />y <br />p <br />to uaaurr thw yualifinl grnunrw•I proq•rh Kuthrr uml r. aluute the infurntutfnn , / <br />'a ' ~ <br />,(/J <br />/ <br /> <br />_ <br />~ <br />l .uhmittcd. I4awl un m. inquin .d thr q•r.on ur q•r.on. who munu¢e thr .yHrm. <br />or thus r.ona dirrctl~ ra- a„mihlr rnr ¢alhcrin thr inLrrmutiun. Ihr inrormnliun /~ <br />{ ~.J/ <br />/~/f <br />~ •rI <br />t ~ _ <br /> <br />f. <br />~ -! ~ ' ~ <br />~ l / ~ <br />i 1 ~ <br /> <br />~ <br /> <br />l <br />~ / <br />/ ~ <br /> <br />/' <br />~` ~" ~ <br />~ <br />wbmiued is <br />to thr hc.t of m, Arn,Mled¢c »nd twln•L true <br />uarurrta urui cnrnplrle <br />/ <br />{ f- <br />_ , <br />. <br />. <br />r <br />u <br />r <br />rnG <br />w <br />thm tb <br />~ <br />mt <br />x <br />altir <br />fo <br />bmiui <br />r <br />b <br />i <br />f <br />ti <br />I SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED . <br />urn a <br />are <br />. <br />. <br />, . <br />¢ <br />u <br />I <br />n <br />r w <br />n¢ <br />u <br />n <br />nrrnu <br />. <br />e <br />nn. <br />incltrlirrg thr p.n.,hilin ..I lino .uul impriwmmcnt fur knowing ainlutiuns. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />E COMMENTS AND txrLAnA l lvn vl- Arv Y vtvL.A l wrva (rrererence an anacnmenrs Here/ <br />., <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES} <br />pISCHARGE MONITORING REPORT D R <br />+. ~ t'.In Ir~rnl. <br />~~ <br />