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<br />PERMITTEE NAME/ADDRESS (Include fanlits .\unrr/lncgtiun iJINJferrnn <br />NAME I,; j N6 <br />ADDRESS j <br />_Efrdpi'>w; i3Ol,~a <br />FACILITY '; M I PAL <br />LOCATION <br />C~RCEK ~_~ 8t7q"6 <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 />f 0 i^, <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION r10_ FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />SAMPLE <br />~ G `, <br />~ (~ <br />S ~( <br />' <br />' <br />I~~ <br />C-~AS <br /> MEASUREMENT . - <br />) <br /> PERMIT r .. _ -- ~ a.•- _: <br /> REQUIREMENT •~ <br /> SAMPLE ~ <br />< /_ ~". <br />, <br />~ ~ - <br />~~I <br />~ <br /> MEASUREMENT I ~~~ '` ~ <br /> PERMIT ~ ° ' <br /> REQUIREMENT - - ' <br /> SAMPLE <br />~ <br />~G <br />~ <br />I i <br />~~~J~ <br />< <br /> MEASUREMENT J ~- '--+~ - <br /> PERMIT ,~ ;: ~ -+ t~ li ~ 1 ~ ~~ <br /> REQUIREMENT ~ V 4 JR T :._ Y I'! X %'N ;f~! ~~: + . <br /> SAMPLE - <br />~ ~ <br />/ ~ , , _ <br />~ <br />, <br />~ I <br /> <br />~ <br />/ /~ <br /> <br />L <br />F, , <br /> MEASUREMENT - <br />~ '' " ; <br />1 <br /> PERMIT ~ ... _ <br /> REQUIREMENT `,~' i-~ ~ ~ ~ ~~ <br /> SAMPLE <br />i <br />~ G <br />~ <br /> MEASUREMENT ~=~ %~` ~.Q <br /> PERMIT ~ - - <br /> REQUIREMENT ~`~ ~ Mh ANNVA <br /> SAMPLE <br />` <br />~ <br />~ .S Q~ <br />/ I <br />~ ~/ <br />r'l~~j <br />L <br /> MEASUREMENT _ <br />- , <br /> PERMIT +;fg ~ ~ :. - , ._, <br /> REQUIREMENT i' IL.`r' "i'~ ~ii'~•,' I.- _ <br /> SAMPLE <br />~ <br />U. 2 <br />~ + _ <br />~ <br />~ ~`n <br /> MEASUREMENT <br /> PERMIT r ,+ # =t : - : r ~ -- - - ~ - <br /> REQUIREMENT i~~DA 1~~J!_ *^ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertih under penalty ur7aw Thal lhi. A~wument and all alWrhmrnt. were t ~~~ <br />~ <br />' TELEPHONE DATE <br /> prelrrred under my direcnon or .nprrci.inn in accordance with a system de~iRrred ,~ <br />-~ <br />I ~ i ~. S 1 ~{ <br />" ' ~ <br />. ` ""'~r • to assure that yrmlified pr nonnel prwprrly gathrr and raahwlr Ihr inrnrmalirq _ _ ,----~ <br />~~ ~ <br />~ <br />. <br />1 suhmiUrd. Rased ..n ms inyuirs or the prnon or penaas w hn maw~s• thr ey tem. <br />or tho.r prnons directly rrclrm•iblr rot KntlxrinK thr information. the infonrarlirm - <br />~ _ <br />1 '. <br />/ L <br />^k~ and complrte <br />submitted i. <br />to Ihr Iw t of m. Lnowh•dkr and brlia•r <br />lure <br />a turatr ` • <br />~ <br />~ ~~ t ~ i C 7 ~ <br />(j ~ '~ ~~ 1 ~~ <br />~ <br />,~ <br />4 ~ , <br />, <br />, <br />. <br />. <br />V - <br />SIGNATURE OF PRINCIPAL EXECUTIVE ' <br />' <br />' <br /> <br />TYPED OR PRINTED 1 am aware that thrre nre .~en <br />ricant penaltirs fur cubmitein~ rape inrormatiua. <br />indudir~ the tnn.ibilin ..I tine and imprhnnmrnt rot knowinK siolutinm. <br />OFFICER OR AUTHORIZED AGENT AREA <br />D NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />F'AGF OF <br />ErA %. 1 ~~~(: tio-. _ = .~. ~.. ,. ~. r ~ lit . ~. <br />