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PERMITTEE NAMElADDRESS I(ntfude PaciGrr:~mne/fnration iJUiJ/nrnti NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />~Ll~` PERMIT NUMBER DISCHARGE NUMBER <br />..j, a <br />FaclurY F Nth f ~,,,-: T ~, w~ MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION '• I Qt FROM TO <br />=.Dl. E'Y E HANSEi'J, VP / .~ <br />Form Approved. <br />OMB No. 2040-0004 <br />OAL STURAG~ TLS VNNAM~f~ U ~ I ~n <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <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 />" .....,- . . ,. _r ~ _ ~ .. <br />- REQUIREMENT ' <br />r" , <br /> SAMPLE <br /> MEASUREMENT i ~ • r .'G.:(?. <br /> PERMIT :: .. .:.: <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~ ,._ . ~" r,:, <br /> REQUIREMENT ~-~ ~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. .. .. ., ,_ <br /> <br />REQUIREMENT ~• <br />- ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. - <br /> REQUIREMENT - _ .' ~., _.; - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT ,... .. ,. <br />_ - ~'i(~ :r .. <br />~~ `: i•a T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT °" ,.r ... , .. ..., ., ., _. <br /> REQUIREMENT .' r-, ~ • - . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif. under penult' of Inw that this doaumrnt and all anachment were <br />n <br />an<I order m <br />dimtion nr w <br />rn ivinn in urcuniutKc with a s <br />slrm deci <br />tad TELEPHONE DATE <br /> p <br />~ <br />p <br />y <br />K <br />p ~ ~ <br />~ry ~ _~ <br />' ~ ~ ~ to unsure thnt yuuli~rd personnrl pruprrl~ yttlher and es ulmte the inrnrmalinn <br />~ <br /> submitted. Bused nn ms imryfn of the person or prrvns who munvRe the ryvrm, <br />C `~ - <br />I nr throe pcrWUts diretllr rrspmvtdc for I;uthrnnR the InG,rmunon. the fnrornutU~xt . r ~ <br />, ~ ~ - <br /> <br />f <br />I -~ - ~ ~ <br />~ submitted ia, to thr ha 1 or ms Anow led>Ze and Irrlirf, Inx•. uuvntle, and complete. ^ <br />(/ <br />~ <br />~ olue. fu <br />Lds <br />1 <br />aw <br />that thr <br />• o <br />e si <br />ifi <br />um <br />e <br />hmin <br />inf <br />8 <br />to - RE 06 RINCIPAL EXECUTIVE " <br />TYPED OR PRINTED am <br />are <br />n <br />r <br />¢n <br />c <br />p <br />n <br />r su <br />ml; <br />r <br />orma <br />, <br />, <br />includinx thr p~xsibility of tint atd imprkonment ror kmreinl~ siulutiom. OFFICERO~i AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />~E <br />.-c, Form ;;320-1 Rev 3'991 Frevous 2J.ID,^,r~. _ - ,- _ I ill, I~ ~I -~ (~:1(l It~l-III. PAGE OF <br />