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PERMITTEE NAME/ADDRESS ~?radudc• Facilltt'Narrrzlocarion ~l Dif~eanq NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS _ <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION . YEAR MO DAY YEAR MO DAY <br />FROM TO <br />' Form Approved. <br />CMAB NO. 2040-OOp4 <br />MIN~f2 <br />(SUI3R UW ) <br />ACt.!TF i•lET T'FS'rrhiG Fr7R r~%~ , I <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ., _ ) r~. - ~. _,;; <br />' ~ REQUIREMENT <br /> SAMPLE <br />r ~, :-. J MEASUREMENT <br /> PERMIT t- i : `, .... <br />:- ~ RELUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/'fITLE PRINCIPAL EXECUTIVE OFFICER I ceruty under ~oalty of law that this document and all atlachmems a•e[t <br />u <br />rl <br />d <br />t <br />d <br />d <br />di <br />ti <br />th <br />d TELEPHONE DATE <br />_ <br />~~ ~ prep <br />er rm <br />on or cufxn tston m necor <br />ance wr <br />a sys <br />em <br />re <br />un <br />rec <br />esigne <br />,~ :' <br />5 <br />~ <br />' <br />~ <br />f <br />~ to sssure that yushtied percmncl pro~rly gmher :md evduatr the wf muantvt <br />~ <br />- ° ~ <br />~~ <br />~ <br />- <br />• suhtmttcd l3axd on my inywry o1'ihe pennn or pcrwm whu manage the ,ystem, --"T`~- <br />l~/r' <br />~~ or those lxrx?ru directly reslwnsiblc tot gathenng the in(ormauon. the infotmatinn -~ s= • r <br />r! <br />- h <br />itt <br />t <br />th <br />I <br />f <br />k <br />w9 <br />l h <br />t <br />t <br />d i <br />• <br />y <br />d <br />G <br />( <br />d <br />l <br />t ~ <br />~ : m <br />~_ <br />s. <br />e <br />>< <br />nn <br />no <br />ee aru <br />e <br />rue. aceura <br />su <br />o <br />s <br />o <br />e <br />c <br />, <br />c, an <br />atmp <br />a <br />e <br />I .gym .~~.~rc dcu thrre arc stgmficant prnalGes fm sut+mitung false mformenon SIGNATURE OF PRINCIPAL EXECUTIVE ,r ~.~ • -' - C ;~ <br />• .~ <br />TYPE OR PRINTED ' <br />m I•rl:rp the ~o,•ihihq of tine end rmpnsnnmrnt for knowing stolntions. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br /> <br />:tr rJ NIYU t~nr LNI`IMI IVI~ Vr MIS I YIVLMI IVI`IJ 1r7C1 C/CIIt:C 01/ OllO t:111fItlrI1J IICI C~ <br />~:DURE <br />c ~•r <br />N5 t3_a 4-part fUiitl. PAGE OF <br />