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PERMITTEE NAME/ADDRESS ~lnc(tuk F,x•uin ,vumen..x•arior, r%ni,~i•rrnr) <br />NAME <br />~~ LI!'1' <br />ADDRESS ' ;t '1 ~! <br />FACILITY <br />LOCATION: <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <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. 2p40-0004 <br />- F i I~AL MUi= HT <br />1SCHAR~ i- Tu TA'r'L.OR !:NL=!<<~. <br />~'U <br />i ~. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. a ::+ .., t ~_-' • ~ T -' <br />' '., r-:- `_' REQUIREMENT ' ' , <br /> SAMPLE ' <br />~;l}? ." MEASUREMENT i <br />'1 PERMIT <br />I "" <br />1= _ ~ REQUIREMENT ~ ~~! <br />'i SAMPLE <br /> MEASUREMENT <br />': PERMIT , •: . <br />F.F ~ REQUIREMENT <br />~ SAMPLE <br />"~'' =' _,-. i ~ :-i ~.' MEASUREMENT <br />r~ C PERMIT F; ;; ## 'i sf ?E ~u ti <br />- - REQUIREMENT t~i <br /> SAMPLE -i ~ .; :; _~.-> <br /> MEASUREMENT <br /> PERMIT .. 4,r y. ,,. : >~•>t • ~ a•#tt# ~ .. ~ ,- - >. .•a~ <br />' li a . REQUIREMENT '.?L?~~ A`. <br /> SAMPLE -; ? ,.r . ,; . <br />-~t.~" MEASUREMENT <br /> PERMIT -__ = I #~ :t'.+-r .,t .: - - . -.. ~# - . , s.. <br />- : , REDUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/'fITLE PRINCIPAL IXECUTIVE OFFICER ~ .~nd> under pcnnlry of lain that eht<d~~.-um~m and III .ina~hnxnt; wcrc <br />J <br />d <br />, <br />i <br />i <br />i <br />d <br />h <br />d <br />d TELEPHONE DATE <br />1 prcparc <br />under my <br />on c r supcn <br />on to eccur <br />attec wit <br />a svst m <br />es <br />trtte <br />vcU <br />s ~ <br />~ <br />~ <br />` , ` ; t t.. ,~surc that qualihcd personnel properly gather and evaluate tht int rnutt.hm t <br />,.; :~ <br />~/ <br />/ , <br /> ,uhmtncd. Raid t u my mywn of the pcrs+m or pcrcnn> who marw~c the spstem, / /// ~ , <br />~ ~ <br />%{ '~ ~'t <br />?~ <br />- ~ ~ <br /> .u thou per;+ms dir tidy rcsp~msiblc (ur gatitenng the mformutu+n the mlonnatiun -' <br />' <br />- _ <br />~ <br />' ~' . <br />l ~ubmiucd n <br />m the hest o(my Anuwlcdge and hritet we :.curate and comptcte /~~ <br />~ ,~ ' <br />~ <br />~ <br />, <br />' , <br />I am aware dmt there art a <br />nitia~nt <br />enalnr` r=.r aibrumne 1:1i\ inlr~rr <br />.rtn~n SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br /> <br />TYPED OR PRINTED g <br />, <br />p <br />. <br />includingtltcpo~abil:r <br />.~(fincandimpnv~r <br />n::cl!hrl <br />~~~•ler~~n, <br />m~ui^ OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . <br />, <br />. <br />~ CODE <br />VVtYIMCt9tJ MIVU CAr WI\MIIV Ir yr MI\I YIV V\I+V r\J In61pI GIIbC aII auaW1NICInJ IICI C~ <br />TH:~ HT ;!-iF~T '~l,~"~TH?.~ ItVF~A~?F f?t Ip r>u~ PFR Tpr, >aF1~7RTF'"i <br />1= ~~~-' <br />t ,,,~-, •' ~-,,.. PAGE OF <br />