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PERMITTEE NAME/ADDRESS rfnrrudr faciGtr AamdLtKtuion if fb;/Jrrcnl) <br />NAME ~ !_~ G <br />ADDRESS ` <br />~'; ; iAlfd STftEI:'i <br />ai: GC 31~i3 <br />FACILITY ; t p Cr4NYCN i~ I i~iv <br />LOCATION _~!•,; ~. ~ 8 j ~9 <br />•: A~?il I ~+i~'•"r0~, M I ttiE F1aRtr~G~R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <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 />F ~- `- I NAL. <br />G i SCHr;;~iUE <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:r.r• - c . - - ~ __. .i_ ~. <br /> REQUIREMENT - ' ~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />" .. , . _ <br /> REQUIREMENT ' <br /> SAMPLE ~ r1 J <br /> MEASUREMENT ~ ~ <br /> PERMIT .. - _ ~ ~ - - <br /> REQUIREMENT •~ ' i- ~ <br /> SAMPLE ~'_ i <br /> MEASUREMENT <br /> <br />PERMIT <br />. x ,• t <br />.~/ <br />f.if,l•..l , i. <br /> REQUIREMENT <br /> SAMPLE 1 % `'~ <br /> MEASUREMENT ~/ <br /> PERMIT , ' ' ,~.. <br />, . <br /> REQUIREMENT .. ~~', r-t.;~ : , , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT t' l-~ ~ i i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - .~- _ <br /> REQUIREMENT ' ` ~ D: =. ~ , r r <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I+'rrtify mwlerlmnalhorlaw Ihnllhi+dikvmrnlandullauachmenl.wrrc <br />i <br />wnh <br />a <br />d <br />ci <br />d <br />' <br />~ <br />d / TELEPHONE DATE <br /> <br />' .a,n in na<ur <br />a s~ <br />m <br />e <br />Knc <br />prrparnl undrr m+ dtrn <br />lrun ur .ulx <br />r+ <br />ancc ` , <br />~` <br />/ <br />~' %, <br />.~ FF 1/ / J ~j <br />/ ~' / " <br />~ ` `- ~ v ~ rr ~' `' to a.+urr Ihal qualified prrurnnrl prnprrl~ gathrr and r+ahm~e Urc mf mnatioa <br />nr <br /><` <br />. who <br />c~ <br />m <br />f th <br />e <br />an <br />~hr c <br />h <br />i <br />d <br />B <br />d ~ <br />J <br />~~1 <br />~~ ~ <br />' <br />_ <br /> <br /> <br />_-{_ . <br />on nw mywn o <br />e Ikn~m <br />p <br />r <br />m <br />m <br />a¢c <br />~ <br />e <br />.u <br />m <br />ur <br />. <br />uv <br />ur Ihuce penon+ duvw~th rr+p.m+ihlr fnr t;alhcring the informntion the infnrnmtion / _ <br />/ t /': /L <br />„ <br />, 2~ <br />I - ~ ~ ~ <br />~ _ <br /> <br />i ~ ~- -/ - /~ 5 <br />' ~ ~ <br />~ , <br />~ ~ ,~ ~ <br />~ whmiltd i., to Ihr Iz+l of m+ knuwlydltr and M•licf, trur. aaruroto. and eumpkte. <br />SIGNATURE OF PRINCIPAL EXECUTIVE / ~'' <br />~ (/ •j O / /J <br />- <br />TYPED OR PRINTED I am awarr ~ha~ iherr arx+i¢nifkant prnahie+ fnr whmiltinglulw information. <br />including Ihr p~.+ihilitl of rmr aml impriwnmrnl (nr knowing ~i,datiun+. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />D <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION of ANY vIVLAIwNS (Hererence err anacnmenrs nere~ <br />TL ~P <br />D FC <br />EPA ^orm 3s2~-t ,, F: , ~ :,, . -,.= - <br />~I~tlls IS R -~-~8rt Ihrm. PAGE OF <br />