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. Approved. <br />TTEE NAMEIADDRESS ?,+,?+.v+ r;:,+u;, ~:,+;, ?,.:;':,,,, ; ;,,; :,•,;: NnnoNn~ po~w'rnnr oisCr+naGE euMirinnorr SvSTEr.t ((NPDES) c:','^ 'JO 2040-0004 <br /> DISCHARGE MONITORING REPORT (DMR) <br />NAME <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />.l'`'~~i- "a <br /> <br /> MONITORING PERIOD <br />FacILITY <br /> YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br /> NOTE: Read Instructions before completing this form. <br /> <br />NO FREQUENCY <br />SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> EX SIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALY <br /> ' /~} I/~~ ~(~ <br /> I ~: <br />,~j <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT - ' • <br /> <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 /> <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 t.'ertir. uuJrr penulty..riaa. that thied.xunn•nt and all alwthmenu were <br />:uaKf under my direa n~~n „r .upeniaon in acrordunce ..ith u +wtem de~igtnd <br />pre ~ TELEPHONE DATE <br />1 _ ~ <br /> <br />ti <br />l'i' • } `' •^ p <br />UI 1>UfC lhat ltUAllrNal pel"gl na't pruprti) guher and ea uluule the information <br />a ehn <br />na <br />e 11x• <br />.trm <br />f th <br />• <br />i `- _ _ . <br />-~ <br />~~ <br />~ <br />~ g <br />ry <br />, <br />n o <br />a <br />prr.am or penun <br />ma <br />.uhmitted. Raud.m A. iwiu ~~~ <br />- ar~p,n.ihle Gir gut hcrinX the information, the information <br />or thn.r Ix•non. dircetl ~ ~ <br />~ <br />3 - ~ <br /> <br />K: ~,•~. <br />•. .ti ~ <br />wbmitl ~d is, to the heft .,I m. An~.w ledge and hrtirf, true. :xrurulq and a:mpkle. <br />$IGNATURE OF PRINCIPAL EXECUTIVE L) <br />/~ ' `! :_ <br />. <br />_.. <br />' 1 nm nwarc that then~prr .:Anifxam peoultirs for wbmittinQ lulu information, AREA <br /> d im <br />rnt fu <br />uwin <br />aiolati.:n. <br />' a <br />ria <br />A <br />cl <br />di <br />h <br />ihi <br />~ 6 OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />m <br />n <br />p <br />mm <br />n <br />g <br />in <br />u <br />ng t <br />e Ixyr <br />r <br />lil) ~~ ODE <br />COMMENTS AND EXPLANATION OF ANY vwl_ra I tuns (rrererence arr arracnmenrs nere~ <br />i r'n+Si- OF <br />