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PERMITTEE NAME/ADDRESS rbrrludeFnrdit.•:4iuno'Lucntion~J'pijjcnnU <br />NAME <br />A~pRESS 1 ts_r__ <br />.,F_C.'T <br />FACILITY ,: ~ _; ;- <br />LOCATION :z~l.'r <br />4 U 'c1' b4E <br />NI tltst4l~ i` t: <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-(X104 <br />F - F' I f~IAL <br />55-2 SI_~T 51"pRA6E TO <br />.~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING DUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT >: ~- ~. ~=. ;- - - ,, '' <br />• I REOUIREMENT ._ ~ ' '• `; T I'-~t;~'- -- <br /> SAMPLE % ~ <br /> MEASUREMENT <br /> PERMIT t ~ „1 <br />=;/,.; ~ REOUIREMENT <br /> SAMPLE ' <br /> MEASUREMENT <br /> <br />PERMIT <br />.;.: <br />- -L1 ~'.- <br /> RECaUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ _ r~r{ <br />- i I - i',I r REQUIREMENT - ' ` , ''i <br />- SAMPLE - <br /> MEASUREMENT <br /> PERMIT r v rP ~~ ## a• # ? ' ? - ' :; P: <br />• - ~ REOUIREMENT ' <br />' SAMPLE _ <br />-~. ~~:~ MEASUREMENT <br /> PERMIT ~; ;~ - . : ~~i: >--~ it-#•fi ;. ' f"t t. <br />:-~ • ~ t •~,j r _.~ - REQUIREMENT . <br /> SAMPLE <br />•=_ -• ~~ ~ .-„ MEASUREMENT <br />I <br />PERMIT <br />~ # <br />}~ <br />R•"~I37 <br />t~`c,.. ; r <br />~ ~ <br />(~„?;= <br />t- _ •. REOUIREMENT ~;~~? ? I.' .~,'.::: _ <br />NAMEITITL.E PRINCIPAL EXECUTIVE OFFlCER ~ ccnd;, under penalry o(Iau that this d[wwucm and a!I a;Lt.hn~rnt. wrre TELEPHONE DATE <br /> prepared tinder my direction or sapcnismn m accordance t, uh a o-p~tcm desiened <br />~lQyy r(~ <br />'- <br />• to assure that qualified pwsnnnel pmpcrly gather and evahrate the nt(orntanan __ - <br />,,,..~~~.~^^^''' <br />+ <br />_~ <br />-- ~ <br />' submittcJ. Based nn my inymry o(the person or persons w-ho manage the system, i ~~~ <br />~Y~ <br />~~ <br />~' <br />-+ ortho.e tnrsotu diratly r~~~nsible for gathering the information. the vt(ormaticm ` <br />~ <br />' <br />_ <br />~ <br />C. r . L :-- wbmitted u, to tlxs bcxt o(my know'Iedge :utd belief. true, arc~rmtc.:md .omplcu. <br />mficant penaltie <br />r <br />~~ <br />r <br />,r <br />for sub <br />nt <br />L <br />~ mtorn <br />th <br />th <br />• <br />I SIGNATURE OF PRINCIPAL EXECUTIVE G 7! r ?'Z ~ ~-' G .~ L_ j <br /> <br />TYPED OR PRINTED en a <br />e <br />g <br />s <br />: <br />;. <br />.r <br />n' <br />at <br />m <br />ine <br />~ <br />mn aware <br />includmgthcpossihifin ni 6m•andimprisonmettt fnrAnnuu~c .~~~i:ui,n" OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aft anacnmenrs Here/ <br />,1 <br />n r= .- ,._ --. -- - - - - - - PAGE OF -- <br />_ I hi> t~ a i-hart lnn?i. <br />