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PERMITTEE NAME/ADDRESS r6tcLtdr Facility :\'umr/l.ucdtiun if I)iffrrrrut NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS _ <br />;. PERMIT NUMBER DISCHARGE NUMBER <br />'~E~ <br />FaclLm =ti. F~ ~. - : ,L,;.:,_ y,. MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />7~ P~ C O I~s i .' FROM TO <br />..'Y 1*.~IRO. FtECt_P.i~IA~ 1Dhi I'lAi,:k{;r <br />Form Approved <br />OMB No. 2{40-0004 e <br />F - F 1!'• <br />A~~~HC~ T <br />NOTE: Read Instructions before ompleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~` '~ <br /> REQUIREMENT <br /> SAMPLE <br />,,. MEASUREMENT <br /> PERMIT . - _ ~ r.. .- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. - ~ _ ~ ~ ~ - , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ; ., -,., ~ ., r _ , . , <br /> REQUIREMENt '`~~`~ '"~'•`' ~'` <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER i aerUl) under penam ullaw that this document and all attachment. were <br />d <br />l <br />r <br />di <br />+ <br />n i <br />io <br />I <br />r <br />d <br />with <br />s <br />u <br />d <br />si <br />d <br />tl TELEPHONE DATE <br /> prepare <br />uM <br />nq <br />rrc <br />on or <br />upe <br />n <br />n uc <br />or <br />ancc <br />a <br />} <br />em <br />e <br />gne <br />e <br />+ <br /> to a+surr that yuall0ed penonnel properly gather and a+aluatr the information <br />~~ <br /> +uhmitted. Baxd nn m. Inyuin of the person or per+ons who manage the system, \ - .,..f <br /> or those persrms dtrea-tl~ rrsgmsiMe for gathering the Inlormatlon. the information <br /> submitted b. to the hest ul my kno+dedge and Arlie/. true, accurate. and complete. <br />itti <br />ti <br />h <br />h <br />i <br />llf <br />ltl <br />f <br />h <br />l <br />l <br />i <br />f <br />1 <br />SIGNA URE OF PRINCIPAL EXECUTIVE ~ <br />TYPED OR PRINTED on. <br />am aware t <br />at t <br />ere are s <br />cam penu <br />es <br />or su <br />m <br />ng <br />a <br />sc <br />n <br />orma <br />gn <br />including the possihility of line and imprlsonmetn for knowing ridatlons. OFFICER OR AUTHORIZED AGENT AR EA NUMBER <br />CODEI YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />II <br />t' PAGE QF <br />EGA Fc.=m 3320- i'iev 3'99 PreviocS edt , _ :., ,:_ ~.:... TIl!~ u a 4-~8ft OI't77. <br />