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-' HP~ITTEE NAME/ADDRESS /lncludcFuciliq ,Vumo•.?wxarion yOr,(jrrcnr~ <br />Iv1 E l hh'' [[~ `I <br />CRESS ~ ~j y ~ fit <br />I LITY <br />~~c:.,T:~~, <br />i!_LAF <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />5- 2 5LL'tT c;i'.": , .~ :~ TC - .' iN/~SYi <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 i L -< ~ r . <br />_...~. REQUIREMENT _. ' . <br /> SAMPLE <br />' MEASUREMENT <br /> PERMIT ., ; I <br />;'. „1 ',;,~" ij: REQUIREMENT _ , <br />• ' ~ - ~ SAMPLE <br /> MEASUREMENT <br />PERMIT ~ =_ -'. s r+ .. ~ '', c" <br />r•; - REQUIREMENT _ ' <br />" SAMPLE - <br />i MEASUREMENT <br />PERMIT ~. ` "' :J I C I ' <br />~:•, ' '. '~ ': REQUIREMENT ;Cis'(: ,- '•inf4'r" <br />' SAMPLE ' <br />MEASUREMENT <br /> PERMIT - } , ., t ~ ,L., ~ ~; .~:,} i ,7 7t~!'T r ra ~;' _ <br />' r•.1j ~;tiff``; `J"., REQUIREMENT ,; <br />_;•; T' <br />? I': '•_ SAMPLE <br />';; ~' :'~EaTME1'•i f "_r'''' MEASUREMENT <br />_ - - PERMIT i r; -}.•r.x~~.ti.* 'r; i_ • <br />_.. REQUIREMENT ~ i•!;''i.'l'~-, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - . `T RiwfG'R r :, T~:: , <br /> REQUIREMENT . . :?r` ~ ._ <br />NAME,lTITLE PRINCIPAL EXECUTIVE OFFICER I certtt} under prnalty of Isw that this dikumcnt and all anachment, wcrr TELEPHONE DATE <br />_ - ~ prepared under my dirrcuon or sulxrt~isinn m ac:,~nlon.e with a .y:Irm etestgnrd <br />~~_ ~ / G ;.x ~; ._~.f_ ~ <br />- to assure that q,wlitied pcrscmnrl propcrlt gather and es.9luate the mtbmtannn _ - <br /> suhmnted. Bawd on my inyuiry of the person or pawns who marwgc the system. `!= „!~,- - _ <br />~ <br />. ~ ~ or those persona d«ruly responsible for ~thermg the mfi,rtnation. the information _ sue' E' <br />~ <br />, - suhmi«ccl i; <br />to the bea of my lnnwledge and behet: we <br />accurate <br />and cumpl-te <br /> , <br />. <br />. <br />. <br />I <br />th <br />t th <br />lu <br />~ <br />f <br />t <br />ib <br />h <br />i <br />tal <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE ~ "~ j r. :~ G% / I~5 <br /> <br />TYPED OR PRINTED am :mare <br />s <br />a <br />ere art s,¢m <br />ican <br />prm <br />c <br />r s~ <br />m <br />«mg <br />k in <br />ormat <br />on. <br />uxhidn z the povih,hn of fine and impns,inmen~ r~r ~nowmg er,daho^s OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />a.vmmerv ~, wrvu enruarvr~t wt~ yr nt~ r vtvuat wrva ~rtererrrn~r an auaennrtenrs Here/ <br />';P Ph'E'": tF' ~V~T' <br />EPA Form .'3ZOn-~ rRa„ 7~gpt Pravinnc art itinnc n,av ha uaarl <br /> <br />