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PERMITTEE NAME/ADDAESS llnrladr Facility .Varnr/Location iJlhQrreml <br />NAME \ <br />ADDRESS ",.., ,. ,__~~. <br />C:O X1639 <br />FACILITY 1. Ft I'i i I tip. ~: ~}~~I~'' l.- )_ }:. <br />LOCATION ~ ~~ ~ I.j t~ l h3S' <br />KARfI~ RFr.I A!~)a1'irtN Malvtnc.~cr <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 />a <br />Uiat~t-IHKVt IlJ CdKA~~~Y GKCt#rl <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0, FREQUENCY <br />OF SAMPLE <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT ~ ~. , , <br />, , ; i ,: <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT .... , ., . . <br />, <br /> <br />1i~, SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />, - : _ <br /> SAMPLE <br />MEASUREMENT <br /> , <br /> PEAMIT <br />REQUIREMENT .. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certil+ under prnalh of iaw that Ihis document and all auachmrnt. were <br />prepared under m~ dirartion or wpenisinn in accordance with a syarm deigned <br />TELEPHONE <br />DATE <br /> to us+urr that yuullfird perwnnel properly gather and evaluate thr infnrma6nn <br />wbmilted. Ba+cd on my inquire of Ihr per+nn or perwm who menrge the system, <br />or th~xu penons dlrecU~ repomible fur gathering the inWrmatiun, the Infnrmatbn <br /> nthmitted i+, to the best of m. knowirdge and he&f, true, aecurete, and completr. <br />1 am aware that th <br />e <br />I <br />if <br />t <br />l <br />SIGNATURE OF PRINCIP ~ 1 <br /> ere ar <br />+ <br />gn <br />nan <br />pena <br />tie fur wbmiuing false infnrnwtion, AL EXECUTIVE <br />TYPED OR PRINTED <br />COMMENTS AND EXPLANATI17N (7F ONV Vlnl including the pussihHih of fine and imprimnmem fret knowing ri~dationx <br />GTInNS /17afurarnrn nfl n-es..ti.Ne...~ .....,.t OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />DE YEAR MQ DAY <br />~F71~h 1~~:1Lt..>EC'TI~:;,I OF 12 :aF,M°L>=5r F'k ':irt~D TO R~C~t <br />PZ_Rf'(3KME'17. <br />EPF Form 33zG-I ;Rev 3'9?; P•e~o~r.~s ec~r~~ns rr; ::.. __ ~ T}uti I~ ;1 -~-~tirt [t~ftll. PAGE OF <br />