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PERMITTEE NAME/ADDRESS rlncluJe f'a lity Nmne L~xul(on ifDifjercnrl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <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 />NOTE: Read Instructions before completing this form. •-- " <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />! <br />' i <br />_ MEASUREMENT ~ - J <br />~ / T11 <br />/<r~r, (/r" ~lc~ <br /> PERMIT r p' - --'! !F. <br />p ~- ~ ~• REDUIREMENT <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/'TITLE PRINCIPAL EXECUTIVE OFFICER I certtfi under penalty of law dun this dcrmmmt and alf attachment. were TELEPHONE DATE <br /> prepared,mdcr my direction nr xupen Sinn m accordance with a system dssigncd <br />_ <br />=~ ~ <br />S <br />' 1 to xssurc that qualified perwnncl properly gathrr and ecaluaie the mtl,rmaUun <br />h <br />d <br />-- <br />/ ei <br />(,";~ - -' <br />, ~. ie system. <br />.-ubmiaed. Based nn my myuin of the person or perwns w <br />o manage ~ ~ <br />~ <br />~ <br /> or thux persuns dvectly responsible (ur gathering the mfurmauon. the nd7xiuation ~ '~ > <br />-' <br />_ <br />- <br />_ <br />b <br />d <br />l ~ <br />~ <br />f ~ ~ - elief; true, accurate, an <br />cnmp <br />Mr. <br />suMnBted is, to the best of my knowledge and <br />b <br />itu <br />i <br />fi, <br />nn <br />f <br />t <br />lti <br />f <br />l <br />l SIGNATURE OF PRINCIPAL EXECUTIVE I ~ ~- ~ <br />~J ~ <br />~ ~~ C <br />' <br /> <br />' or su <br />m <br />n <br />rma <br />n <br />Ism Marc that therr :rta agm <br />ican <br />pena <br />es <br />ng <br />a <br />sc <br />f <br />d <br />f <br />k <br />i <br />• <br />l <br />i <br />i OFFICER OR AUTHORIZED AGENT ~ <br />NUMBER <br />ODE <br />YEAR <br />MO <br />DAY <br />OR PRINTED <br />TYPED on. <br />ne an <br />im nv~mixnt <br />or <br />now <br />n <br />vu, <br />at <br />6 ~ p 6 <br />rr~irlm ~ the sih:h:y o <br />t <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Heterence au anacnmenrs Here/ <br />2 Rc~IF <br />~nwlrl r~ <br />1. A <br />-- - <br />PAGE GF <br />~ ~_ ~;,~~. ~- , _ 1 hl, I, a -I-Dart tern: <br />- - <br />