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PERMtTTEE NAMFJADDRESS Nrtdwie Fa~ifin h"umrll~ratinn if fAJferenA <br />NAME <br />ADDRESS _. `~~ I': ~ ~ .. _ -. <br />t°U #3263Q <br />FACILITY _r, • " ~, __ ~~^PIF'L ~.:~ <br />LOCATION `, t; ~ r ~l E'~. I f3.~~ ~~ <br />.... ._ _..... , .... . ~ .~ .., ~ n n,c <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approve0. <br />OM8 No. 2040-0004 <br />• • <br />cl TR z >? ; ~ae~ <br />NOTE: Read Instructions befo~ completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />of SAMPLE <br /> EX YSIS <br />A TYPE <br /> AN <br />L <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f + <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I +rrtiq uodrr prnuln of law thul Ihi+diKUmrm um7 all allachnunr. wem TELEPHONE DATE <br /> prepund omler rm direction nr supenisiun in s-cordaner with u st stem desigmsl <br /> u. a+wrr that yualilied prrs:mnd prvgx•ri~ gather amt rcaluate thr inU:rmatlon <br />~ <br /> +uhmiurd. Rand on m) inyuin of thr prr+rn+ or poems who managr tlx s~sk-m. <br />ersons directly nponaihlr rnr gathering lhr infarn+atiun, thr inturmatiwn <br />ur thus _ <br /> p <br />submitted i., L. the Iwst of m} kno+cledge and Imlief. True, acrurute. and complete. $IGN:QTURE OF PRINCIPAL EXECUTIVE ~ ~ I <br /> I am aware that them arr signifia-ant penalti<s fnr +uhmining tali intormatbm. AREA <br /> nwi <br />+iolation+ <br />tf <br />em t <br />e 6 <br />d i <br />i OFFICER OR AUTHORIZED AGENT C NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />mpr <br />sonm <br />o <br />n <br />ng <br />itxluding the pos•ibilit. o <br />inr:m <br />COMMENTS AND EXPLANATION OF ANY vloLAllurvs trreterence an arracnmenrs nere~ " <br />I' ~ !_ t I"1I ~' ~,QPI_'! ~D r-nt, ~ -' C7~'R. 2•~NR PREC IF' EVENT, TSS, <br />• --.+ <br />PAGE OF <br />_... F-~rm __~_~-1 ~Rav 'jyl~ Prec~ous r;;incn~ _.• _ ~___. T'~lf~ !'~ ,. -1-t`~:fl fni"tr, <br />