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<br /> ~', ,.:~ ; <br />TTEE NAMElADDRESS:/nr'I~.J~ F~;.i;u, \,;~n, 1,.,,,;,,,; , i :r, ,, ,;; NATIGNAL POLLUTpNi UI~CNARGc ELIMINATION SVSTEM ((NFDE$~ _SI,~Ej PJv ZJ-7U'UVU~ <br />NAME DISCHARGE MONITORING REPORT (DMRJ <br />ADDRESS <br />' <br /> PERMIT NUMBER DISCHARGE NUMBER ''-~~ T <br />FACILm MONITORING PERIOD <br />LOCATION YEAR MO DAY YEA MO DAY <br /> FROM TO <br /> • NOTE: Read Instructions before completing this form. <br /> PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> • <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />A <br />EM rc <br />SU ~ r <br />v~~~ <br /> ME <br />SUR <br />ENT ] <br /> PERMIT ' fti~..~`'CR'i :. r-:::-:--., i-.. _ .- r... ~ .- ., -, .. ~: - ' <br /> REQUIREMENT I s I`a5T MAi _ MC%r ~- <br />SAMPLE <br />MEASUREMENT <br />PERMIT ' <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT - <br />SAMPLE <br /> <br />1 <br />=Fq F_;rn, ,,~ F%.. <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 />lFFCER I crrtif~ under IK <br />prepnrrd undcrr <br />. ;~_ to ut ura Nut qu: <br />~ ,r whmiued. lSa~rd <br />.uhmittrd is, t.. tier br.t .d m~ AnoN 4dRr and haiief, trur, a vvrate, urxl enmplele. <br />I m11 YN9re thal 111CR nrr MunlrN'Lnf pcOallie+ fOf NihmltllnK fula infOfnliti:M, <br />indudin~ the pnsihQit:..I finr and impri~mnunt Gar MnuwinK ~iolutinro. <br />VIOLATIONS (Re/erence all attachments here) <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />:LEPHONE DATE <br /> <br />`z~ y G'1~ ~ ~ G~ I <br />NUMBER YEAR MO <br />I';i. , ~, F'~ <br />