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PERMITTEE NAMElADORESS rlnrluJeF:xdlirv:Ywrc.9.+xruionifDi,(/imnU <br />NAME ~'i:i. Er.~`'+I14~ir L_L_~:• <br />ADDRESS ~• - t~, i'I ~'?c <br />'"' FR'i•A"i S3t,T Tt7N ~'Oi,D <br />FACILITY _ i- i=, rii I r:E <br />LOCATION _t{~ ~ Q g 1 LZ9 1 <br />I: f~L~Lf 7 N~ 1 CIN, GIWPdER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 20a0-000a <br />J Li R .:~ i; . <br />PERMIT NUMBER DISCHARGE NUMBER -- F I NAl_ J-~~ <br />,- t: _ <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ~C <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO- FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE .. _ <br /> MEASUREMENT <br /> PERMIT ,~- .~. k .~.- ;..~ --r - <br />- -~._! ~.- REtUIREMENT ~ ~: ~ i 1 I P.1 I Mtn 1': i9F,X I MUT9 :_i`•.; <br /> SAMPLE ~ -r : .~ :' ~ ,. , <br />' ~ -, -. MEASUREMENT <br /> PERMIT -. : a •3t •:~ # :E ~ ~ 3r # ~si ~- # ~ ~, ~ +' .. <br />~- ~ REQUIREMENT ~ 3vI'ir:~ HUG i IX 7U w':1 P'lON 1-Ff <br /> SAMPLE "-t~~;: ..:.+ -- <br /> MEASUREMENT <br /> PERMIT -• ~ #?t-rF# ~ #4F ,. ~ 14 .. ._ <br />: '. REQUIREMENT "` ;`'~ ;- "'; X lrlCJ\1Tli <br />. SAMPLE ~ , r ; <br />- MEASUREMENT /1 f.. <br /> PERMIT ###~1~•a~• .. - .~ v:i ~~ g l: ~ , <br />- t . t_1'~ -~ - '~': REQUIREMENT I ,'G :1 F? 1 LY hli7f~!TF <br /> SAMPLE -: -> n•f ~~ .. <br /> MEASUREMENT <br /> PERMIT it#3Fa## 9f-; -f# -z jt sr-a ~ -~ .. d F1 t.. <br /> REQUIREMENT ~~FN f <br /> SAMPLE , `_; _, , -, <br />-.- MEASUREMENT <br /> PERMIT ~- " - t z ~ a .'•. <br />-. REQUIREMENT _'«=, <,`.•',:, .- ~'; i •_'t` !•'IX <br /> SAMPLE <br />' MEASUREMENT <br /> PERMIT - - <br />. REQUIREMENT ' t•~' ;' i'1P~ Y 1`~='_ <br />NAME.,TITLE PRINCIPAL EXECUTIVE; OFFICER I certify under penalty of lau thm thro d+kumcm and all attachmrnls were <br />~' <br />~ TELEPHONE DATE <br /> prepared under my direction ur sut+-rvi+ion in accordance with a sy~trm dr.igned ~, <br />~ <br />~ <br />~~/ ~~/ > I !-~ <br />1 Ye r" !l , <br />~l • j <br />~ ~- to assure that yuutiti+~ prr.onnel properly gadter and rvnluatr the infr~rmatwn <br />submntrd I3aed nn my m <br />wp• of the <br />rison nr <br />rr,ons whn manage the system , ~~ ~ <br />~ <br />_ ~ <br />; y <br />p <br />, <br />p <br />ur those perx+ns directly tesp:atstble for gathering the infermahnn. the mfomtatian ~ <br /> <br />%.' <br />wbmittai +s, to the hest o(my knowkdgr ;md b. hci, true, accurate, and cumplrtr. <br />lse inf <br />m <br />ti <br />I <br />h <br />t <br />h <br />i <br />ili <br />l <br />:; <br />t <br />i <br />i <br />f <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />'^ - <br />, ~ <br />~ ~ <br /> <br />TYPED OR PRINTED ng <br />or <br />on. <br />am aware t <br />a <br />t <br />ere are s <br />~.m <br />cant prna <br />r.r+ <br />~r w <br />+m <br />tt <br />a <br />a <br />ttxluding the poss+bility of One and impn+nnn':cn; L~r know mg vtolauons OFFICER OR AUTHORIZED AGENT A <br />CODE N ~MB <br />YEAR <br />O <br />bAY <br />COMMENTS AND ExPt.ANATIUN VF ANr vwLAf wNS tr+ererence au arracnmenrs nere~ <br />~- ? IOG REPORTED <br />`'OLI??~, i ;MIT <br />SEE I. D. 1 D+ P 8 TOS <br />YR : , P.1._ _ <br />I:1, ? ,. - ;it-i in;,~ - - PAGE OF - <br />