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PERMITTEE NAMEIADDRESS ,lrn•lude Fu-iliq Nmuz/Lneufinn ~DiffrrcntJ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />,•< _ , .- <br />ADDRESS ;l~ <br />RC PERMIT NUMBER DISCHARGE NUMBER <br />FACILrTr MONITORING PERIOD <br />• ~ YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />MINOR <br />(C l'f3R <br />F - F' <br />PPr T. <br />Form Approved. <br />OMB No. 2040-0004 <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 />• r r _„ - - .. ~ r: MEASUREMENT <br /> PERMIT .- - nr.: ,_~~,T ~\EF'"-i~! i _'F~~ <br />- _ •. REQUIREMENT '('L'F; r`-',''-~ DP1l:k.':' <br /> SAMPLE - <br />m;1 ;-i _ r,.- t ~- MEASUREMENT <br />• PERMiT -.- - > .., F:Ei' ~ t'ti:.f't1F', I i <br />'; •~;:.,' REQUIREMENT ..'~'f,~ .•Lk.Y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _. <br />- ~ ` •_: REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMtT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMP!-E <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TTTLE PRINCIPAL EXECUTIVE OFFICER I ccnd) under penalty of law that this dtwumrnt and all a[tachmznt, wcrr <br />d <br />d <br />i <br />d <br />i <br />d <br />d <br />d <br />l <br />i TELEPHONE DATE <br />. _ prcparc <br />un <br />er my <br />trccnnn or stt~n <br />von m accor <br />ancr w <br />t <br />i a system <br />cs <br />gnz <br /> <br />,_ f _ -~ <br />~r <br />"~ <br />"~` ~ ~ ~ l <br />/ <br />' to as+un that ,{uahficd t><rwnncl propcrly~ gathcT and c+~aluate the intermntiun <br />" <br />•. L <br />S <br />- <br />iJi <br />/ submitted. Baud nn me irtquin- of the person or persons who managz the s•strm. ~ .f` ~ <br />~ cu thcxe pcrwt>_s directly res~,nsible for gathering the tnfcmnmion, the information _ <br />~ <br />`- submitted is <br />to the Fast of my kmnt ledge and t+clirC. tine. acauatc <br />and complete $j - <br />- ~ <br />, <br />,~ . <br />, <br />ant au ue that thc:c <br />+rc amv he an! Pcaeine. t•n .uhmut~re t <br />,I<c mr,mtam~n GNATURE OF PRINCIPAL EXECUTIVE .• <br />-:~ <br />ti <br />l ~ _ <br />~-~ <br />TYPE OR PRINTED . <br />. <br />. <br />•~,.~h~ht <br />r:. <br />meludir, <br />, i t~nc ::n,~ n <br />nm:~nt t <br />.r hu:~anie ~i•4:~n„r. <br />me OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br /> p <br />~p <br />. <br />g <br />. <br />. <br />. CODE <br />ryVMMENTS ANU tXPL.ANAIIVN VF ANY VIULAI TUNS (Reference all atiacnmenls Here) <br />~}US IS 8.4 p$11 lOtt'll. PAGE OF <br />