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PERMITTEE NAME/ADDRESS r/nrfudr Pacififs .~'omrll~tation iJl)iJ/rrem) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) ~~ <br />PERMIT NUMBER DISCHARGE NUMBER F <br />.~ <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OME3 No. 2040.0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY <br />DF SAMPLE <br /> EX S TYPE <br /> ANALYSI <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE _ <br />~ f <br />/ <br /> MEASUREMENT ~ ' ~~f ~~-fig <br /> PERMIT ~ ., . ,_: •~; -. - •_ " <br /> REQUIREMENT <br /> SAMPLE -~( f ~ <br />~ - <br /> MEASUREMENT ~ ' ~ ~ / ' I ~~ -t <br /> PERMIT ~ i. , - <br /> REQUIREMENT ~ :: +;~-'. ` <br /> SAMPLE - -~< <br />/ <br /> MEASUREMENT ~ I C•~ a <br />t-l i'~ -I '~~ <br /> PERMIT - .... -s: _. <br /> REQUIREMENT .. ~• <br /> SAMPLE •• .n~ ~ <br />r <br />'~ R <br />? <br /> MEASUREMENT ~ ('; ~ ; ~ , 1;~ <br />~ ' <br />~ <br /> PERMIT i .#= .. - .... - -~ , r-. <br /> REQUIREMENT <br /> SAMPLE <br />, <br />~ <br /> MEASUREMENT I ~ ~) <br />L~ <br />"• ~ <br />I ' <br />~ ~ -~~ <br /> PERMIT .` Ir~ .: u ~ _ -._ !'~ .- _. <br /> REQUIREMENT ~ ~ • - <br /> SAMPLE ~ ~j.' <br />~ <br />f1 <br />' <br /> MEASUREMENT - ~% ~ ~ `~`- ~~ , <br />1 <br />L k. <br /> ' ; ~• - _ - . ~- :_: c• - - <br /> PERMIT =~ , <br />~- _ <br /> REQUIREMENT ;~, " <br /> SAMPLE <br />~ I <br />~~ <br /> MEASUREMENT ~ I r )C'~ ~k.~ <br /> PERMIT -- ~ - - <br /> REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I crrtitc under penulq d'law that this dia"umrnt and all al Wchmrnd were ~ ~- _ ~ /'~ <br />"'~` TELEPHONE DATE <br /> prrporcd unlrr nq dirtt~u~ai ~.r wpeni.inn in aa'rordance with u +>atrm dr.igmd <br />- ..-1 ~ _ 1 ~ ~ ,- a <br />• ' ~ to r<cure that yuulifiad pen~~unrl prnperl} gather and eawhwte the infnrmafion <br />~d the Him nr nom who ntum a tM• s)drm <br />h <br />ht <br />ft <br />cd <br />n m <br />d <br />J ~-1.~~- ._' ,~ j ~ ~ <br />~ <br />-- l -' ~- <br />J*-~ <br /> , <br />m <br />. <br />o <br />v <br />n~ mn <br />eu <br />c <br />u. _ <br />_~ <br />/ <br /> or ih~ra• Ix•non. direetlt rc.gm+i Mr !nr Kalhrrinfe the information. the mfornw6~m / C - , <br />__ <br />t <br />L ~ ~ - - +uhmitted i<. to lha• M+t of ma know IedKr and beher, tn~e, ua. urotr, xnd canpkte. <br />SIGNATURE OF PRINCIPAL EXECUTIVE _ -~ _ '-~'~• •-1 iJ f ~ j ' - <br />- !_ , ~~ --.- <br />a <br />- <br />-'-" 1 am aware that thrrc aro.i~nificant {Knritiaa fur.ubmitt~nQ falu informatNm. AREA <br /> eN(o <br />knoein <br />;.uawtion. <br />th <br />ibilit <br />tli <br />mdi <br />ria <br />i <br />l <br />li OFFICER OR AUTHORIZED AGENT NUMBER YEAR MQ DAY <br />TYPEDORPRINTED . <br />epin• <br />co <br />n.. <br />mp <br />mm <br />r <br />> <br />m <br />tu <br />nk <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference .al! attachments Here) <br />?CA?._i_"~ ,ZGf,1r1- Pfi'F' fiETl~4E:>•`N TFr.' ?; <br />EP.i ~p'fn ?32C-' Pt-r _ - -. _ r~ll~ I~ ;1 -+ I';IIf (r„I,-~ PAGE OF <br />