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PERMITTEE NAMEIADDRESS Nntltde f'acAuy .Yamr/lnrmion if Ui/finnf) <br />NAME • - L C <br />ADDRESS ~ + ' '''• ' - ' ~- <br />i i 1`I~tIN STt`'tEET <br />.fir, GC 81 ~'8C <br />FACILITY •_ ;'~[- ~i~N~'tJ~: MIh#E <br />LOCATION )1'v %[? 81L~9? <br />'~ ASP>ivGTOi~, MIltiT= MAS~;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 />F - ~ I IVfiI.. L: i <br />rJIS%HfinGE TG L.Gr'T+~;~~ITi=: ~.Ai~JYGP: <br />X ' <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING OUALfTY OR CONCENTRATION ttJQ, FAEOUENCV SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />. <br />_. - <br /> PERMIT ~.. ,.. , ,. . ~. _ ,. _ <br /> REQUIREMENT ~,'':' Y ` "i''I~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - :r r ,. •a .Y .. <br /> REQUIREMENT - ''•'~' - '~~' ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT " '~ - . ~ .~ , .. , <br /> REQUIREMENT ~ ~' ` ~ I-- ' <br /> SAMPLE `"l, ~1 <br />,~ <br /> MEASUREMENT ' ~ <br /> PERMIT ., .. , .. _ - ~ ... .. _. ~ ._ .. <br /> REQUIREMENT ~j ~`'v r' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ _ <br /> REQUIREMENT ~ , '~ °I'`I ~ ri <br /> SAMPLE <br /> MEASUREMENT <br />- <br /> PERMIT - . <br /> REQUIREMENT ~ ~'~ {s is ' ~ <br /> SAMPLE <br />• MEASUREMENT <br /> PERMIT ~- •~ _ .r .. ...... • - - <br /> REOUIREMENT ~' '' r'` ~' • <br />NAMElfITLE PRINCIPAL EXECUTI E FICER I °~ rti4 'nidrr pa•nalt+ n( law that Ihi+d~wurna•m and all aunchnxnt. were <br />yreparad ender m. direction or +upa,~+i+inn in o curdaru~e with a .y+trnt deigned <br />~ /~ TELEPHONE DATE <br />/... / q <br />p ~~ 1- ~ i <br />. (i ' ~ to assure that yuafified pcnonnel prnperl~ gather and e+aluate thr information ~ ~ ~ <br />~ <br />, <br />l~ (/ / -~ C whmitted. Rx+cd on m~ inyuir+ ur Ibe prnun nr perm~nr who manage the •7+Iem. _~ ~lf~ ~ ~ ~/~., /~ ~~`J <br />v <br />~~~ _ i r ~-y ~--r <br />~~ --- . <br />~ or tho,e prrson+dim~d} rcrpnn+thk [or gatbrring the informatiom, the information Sif/// •• <br />I{1/ ; ~ <br />' ~C/~: ~ y7 <br />• C %~ / , )y <br />i /) U/ <br />[ <br />' <br />- ~ <br />~~ ~ ( ~ '• ~uhmittrd is, h. thr he,t u(m) Mnowhvlgr and M•lirf. irtm, aacurule, and complete. <br />I .ou aw.u ~ that there are signifw•anl penaltic. Gar .uhm111inF rake infurrtinlion SIGNATURE OF PRINCIPAL EXECUTIVE ~ c --~ <br />, <br />TYPED OR PRINTED u~rludw~ th. p,.s+ihilit~ o(finrmd impri.onnunt ter knowing+iulati~~u~. OFFICER OR AUTHORIZED AGENT AREDE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLwrva I Ivly ur Arvr vwLa I Ivrvs tFfererence an arracnmenrs Here/ . <br />'Jf <br />~ . ~a F t t, ~~~~ , ~~ , _ -, .. ~ ~~~. . <br />form. <br />