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PERMITTEE NAMEJADDRESS 1lnrludr Fatilih•.1amr/l.xutiun iflhffrrrnfl <br />NAME L.LG <br />ADDRESS ~ - <br />~'i- fltAT r~ S'i N ~E T <br />~n ~,Q E~2QB <br />FACILITY : T;~ l,~~l'~(~y ~ j jt}~ <br />LOCATION •,~ t„~; $ j ~r9 <br />-;. ~rll)Titi3uTOF;• MI~~ P9r~f+::~GEr~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />t 51JDR DK ; <br />F - 1= I f~tRL <br />L s Sr'HARGi= TIC I_(7REi'dC I TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION f~Q, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .,- .. -,. .. ~- - - <br /> REOUIREMENT '` ~,„ ' ' ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ - <br /> REOUIREMENT ` ; , ".'i : ~ •• f'i Y <br /> SAMPLE ~ ~~ ~ - <br /> MEASUREMENT I - <br /> <br />' REQUIREMENT <br /> SAMPLE ` <br />` <br />~ <br /> MEASUREMENT ~ + <br /> PERMIT .. ~ y. .. ~ _ , <br /> REQUIREMENT ;), , . f•.;; tilt j; r ; }.~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :: , . >; ., _ ., .. :._ <br /> REQUIREMENT ~- ~ . - : i r':: _ ~ Pt ~ ~i~i ? ~-i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - - <br />~ ~ ' <br />~' ~ ~ ~ T . _. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _. ~. ._ .. ... _.. .. --- -- - -- <br /> REQUIREMENT -<Ui='.~ ~ . '_' ~ •'. I '~" <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ~rrtif~ under Prnau~ wnaw thm mi. d.KUment and all attxrhmcnf++rrrc <br />i <br />h <br />k• <br />i <br />d ~ A <br />, TELEPHONE DATE <br />' " <br />~ <br />~ pn•pan•d under m~ dirnYion ur wp•nition in acrnnlanea• w <br />t <br />a »+tem t <br />+ <br />gnr <br />~ f ~In /,, <br />J <br />/ <br />// <br />/ <br />~/ <br />~ ._ <br />< <br />~_ vt ~i Q /f ( <br />~ C <br />/~ <br />r r - -- - 4ather and eauluntr the informxUun <br />i•• ~++urr that qualifrnl Iw•r.onnel pruperl ~ <br />f th <br />wh <br />nu <br />th <br />tem <br />i <br />i ' <br />'! <br />y <br />'t <br />/ <br />.A/G'/ <br />~~ ~~ <br />'1 <br />- <br />r <br />"", <br />` ~ ~. n o <br />r Prrsun or prrcum <br />o ma <br />Re <br />e }~> <br />. <br />+uhmitted. Naxd nn m~ <br />mtu <br />or lhaae Persom dirrcW rrslw~mihlr ka Ratluring Ihr infornuuion, the information ( <br />/ <br />V <br />f <br />~ ~/~j <br />, <br />i <br />Ir-' ~ C~ ! +uhmiltad i+, to the be+t of m. know InIKr and hrlirf. true. arcurnte. and enmyleR•. <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~~~ ~ ~~ i `1 ~ ~ D ~~ <br /> <br />TYPED OR PRINTED Irm aware that Uw~re are sittnirn•ant Ixnaltie+lor whmitfing falx• information. <br />Inahtdiny thr Iwmibiht~ of finr and impriumment for knowin>;+iotatlom. <br />OFFICER OR AUTHORIZED AGENT AREA <br />DE NUMBER <br />YEAR <br />MO <br />DAY <br />GUIVIMtIV15 AIVU to YLAI`IMIIV IY Vr' MIYi YIVLAlIV19A (r7CrCrCnt.G an ouat.a ntrctna trcr c/ • <br />? <br />~ _a,~ . r:~ • ~ _. ,~ . <br />l OYR ~ ~4HR PREC IP <br />This iti a ~-part icrrm. PAGE OF <br />