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Form Approved. <br />PERMITTEE NAMEJADDRESS r/nefade Faci6ty:Veme/lornrinn ijlhJjurnll NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) OMB No. 2040.0004 <br />NAME DISCHARGE MONITORING REPORT (DMR) <br /> ~ <br />ADDRESS ' s_: ;.... ~ U i. 1-1"; YC!N i ~ .; ,_ , <br />~~ irtE~T ''Ii~'I`! `;TRIP PERMIT NUMBER DISCHARGE NUMBER _ ~IA.l~li.- i_.Af <br /> <br />FACILITY E~~t_ I'TO t~ANYpN M? P•~ : MONITORING PERIOD <br />LOCATION ; j t~p•. --~ 1=3, Y R MO DAY YEAR MO DAY k <br /> FROM TO ~ <br />i h f-SL•IU _ <br />I Nc~-TO{`d, i'e .1 . ~;=_ i'iAt~iAC ~ NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• <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 r.~ - .: ;-'~'` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT ., . <br />' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. \ <br /> REQUIREMENT ..-~ ~_ A `~ <br /> SAMPLE {~?'/ ~' <br /> MEASUREMENT ~~ ~' ~' <br /> <br />PERMIT . .. - _... <br /> <br />REQUIREMENT <br />' ., <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ..,, - .. . _. <br /> REQUIREMENT `~ ~ ~ ` ~" • <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - .. <br /> REQUIREMENT _ ' i'; ' ,~ is ~ ~ ° ' i t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ _ _- ~ _ - _. <br /> REQUIREMENT • ` =' tr`' ; ` ,' ' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif. ender penultr of Irw that th++d,KUmrnt red tJl rtlachmrnt+wrre <br />d <br />di <br />ti <br />i <br />c <br />.+ith r <br />+te <br />de+i <br />rd <br />d <br />l <br />i <br />d TELEPHONE DATE <br />__ _ ~ <br />/ ~ J Ll <br />u} f~ ( O v~' <br />~ <br />i +` ~, <br />' on or +upen <br />n rcrnr <br />rn <br />e <br />.~ <br />m <br />Ko <br />prrprra <br />un <br />er nn <br />rec <br />+ <br />un <br />to x}wre Ihat yu:+liri+d prrvonnrl prnp+•rl~ ga1M•r wxl e+rlurte the infnrmalinn / %! <br />~ ;~ <br />~ <br />. <br />, <br />~ <br />(/lam / <br />/L C \ +ubmiltrd. H,rvA nn mr imluir~ a( the prr+on or prr.an+ wbo mrnrge thr +I.tem. t~ <br />~ . / ,~ ~ .L,. <br />,t ` <br />^~ ! _. f- ur tho+c penon+ dirn~tl~ re+pm+ibk for krtherint; the informr6+m. the in(armrl{on ~ <br />V <br />'~ <br />I ~ Q /[J <br />! recurrte <br />red complete <br />+uhmithd F <br />to the he+t of m) knowlyd~e and helix( <br />True _ _ <br />is ~ ~ ~~"/i ~ / ~J <br />°" / / / <br />- ~ ~ , <br />. <br />. <br />, <br />ti~e~ <br />t th <br />i <br />if <br />m <br />! <br />ittit+ <br />F <br />d <br />r i <br />G <br />1 <br />th <br />lti <br />h SIGNATURE OF PRINCIPAL E ECUTIVE /. _, ( <br />TYPED OR PRINTED . <br />gn <br />or cu <br />m <br />k <br />. <br />+ <br />n <br />~rn+r <br />am rare <br />a <br />ere rrr + <br />iea <br />prna <br />o <br />including the po++ihiliry of fine rrd impri+onment for AnuNine +iolation+. OFFICER OR AUTHORIZED AGENT ARpE NUMBER YEAR MQ DAY <br />t COMMENTS AND EXPLANA I wN ur Alv Y vwLA i wlvs Irreverence au arracnmenrs nere~ ` <br /> <br />7LIBS L1F4IT APPLIED FOR t=1QYR, 24H1 <br />>'R~ ?4~R PRECFP FV~i•dT 5Uf3..IECT T!-J LIUI <br />PAGE OF <br />(,~rii,. <br />~t1~ <br />