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PERMITTEE NAMElADDRESS /lntlud,• F'ac•ilin :\'umc•.'(.,..dion rJU!j~crrnu <br />NAL1E <br />ADDRESS "~; , ~_ <br />FACwrY <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 />X <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING DUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />~ OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE . . <br /> MEASUREMENT <br /> PERMIT i; . ,•.r: s _ - <br />L : '' i _ ~:; V•~~_~.. REDUIREMENT .. <br /> SAMPLE <br />,~.:[.? ..- MEASUREMENT <br /> PERMIT * , <br />•~: i-.'V" '~ ral.l.l'r REDUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />' PERMIT • '~ :~;i :- a ; c '; K 3f•t ;. - ~:: ~:_.: i <br />' ~ REQUIREMENT <br /> SAMPLE • <br /> MEASUREMENT <br /> PERMIT i' ,. ~ fi ~ ; .. <br />i ' REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT K r to t , is ,• -. - . -• <br />- r_ •. ( ~ l;._!~1 ~- ;.f• ~: REQUIREMENT ~~L:r r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~ P -,i? : -• ..... .. . z'r ; - hi;. t ~ ~ ` n,. <br /> REQUIREMENT ~1t_lPaTl-i <br /> SAMPLE _• <br />r - MEASUREMENT <br /> PERMIT .. '- ~~}=" ;: 'f i~Y i Trl .f2 , <br />• REQUIREMENT , ; (~ 7 n , . •, i.: <br />NAME,ITITLE PRINCIPAL EXECUTIVE OFFICER I ernti•. under penalty of Iaa that thrs d.wument and all attachments were TELEPHONE DATE <br />. <br />- _ pr-parrd under m~ dmxuon or uprrvrsron m acaxdnn.e with a .}•stem desi~r: i <br />/ <br />~.,- ~ ~-i ! ~Yi-y . ,. ~ <br />to assure riot qualified permnnel properly guthcr and evaluate the mforntation <br />~ <br />_ <br />_ <br />" _ <br />- <br /> submtaed. Haled on my myuiry of the person or penoos who mansgc the .rystem. _ <br />_ <br />~.- t 1- _ ~, - ~--~' i <br />'~ <br /> <br />~ ur thou pcnnns directly responsible fur gathenng the mfi.rmarion. thr information ~ r~~ - <br />:% '~ 1 <br />.% <br />Y i - .ter ;., <br />'" submined is. to the best of my knowledge and ixlicf. into. ac, unite, and complete <br />rh <br />I <br />r~ nom <br />,: <br />ri th <br />n <br />t <br />J <br />f <br />f <br />h <br />i <br />r <br />( <br />i $IGNATURE OFPRINCIPAL EXECUTIVE ''~ i /. ~ ~' ~/ ~~7 _' - ~ .~ ~ S <br /> . <br />:. <br />. <br />e <br />ere are <br />gm <br />iean <br />pen. <br />ue. <br />,r ,u <br />mr;e <br />m <br />se informat <br />a <br />on. O <br /> <br />TY D OR PRINTED <br />...'~•~.~~; ~ the p~~..~t+ility of fine atul iny,r,,,ror•,r„~ t•rt l.n.•.~me violation`" FFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />~r,~...~.,r.. , .r,,,.r....,_._ <br /> <br />EPA Form 332 0-1 fRt~v. 319 91 Previous e dftiors may <br />....... ~........,......o...~ ..~,~~ <br />•' HR REC <br />PG. ~. FRP, REQUZF.~MENTS <br />. 7. PG. 14. <br />I ~!i~ Il a -~•~~,trt lt~!-111. PAGE GF <br />