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PERMITTEE NAME/ADDRESS ilnclatle Frstilq~ .Yamr/l.rrrrti~.n r/ /6Jjrrrnri NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMRf <br />ADDRESS <br />'. +J X t PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY ~ ~ r9 I ~,I}. i_; ;=li'tF':., L,~ YEAR MO DAY YEAR MO DAY <br />LOCATION ~~ ~;,~I $1 ~; FROM TO - <br />KFtRQ+ ~tErt_AInATTC7N MAiVAGE~ <br />Form A¢proved. <br />OMB No. 2Q40-0004 ~ <br />NnTF• Rnar1 Inctn +rtinnc Fsofnrc rmm~lcfinn chic form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> OF <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />, - <br />w~ ; / <br />^ ; <br /> MEASUREMENT ~ y : ~ <br />i <br /> PERMIT ~ ~ ~~ <br /> REQUIREMENT <br /> SAMPLE <br />~ <br />, <br />/ <br />r <br /> MEASUREMENT - <br />`- ~ <br />V - <br /> PERMIT ' ` <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rrreiy under pemlt~ ul law that thi+J+KUment and all mtuhmcn~ were <br />d <br />d <br />Ji TELEPHONE DATE <br /> prepare <br />un <br />er m~ <br />nrtiun ur super. i+iun in accordance wHh a stem designad <br /> W awun• that qualifird prrsonnrl prvgx~rit gather and es a{uale the information , 1 <br /> suhmittrd. Nu+ed .m m~ inquin of the pcnnn nr prr+ons whu manage thr +y+tem, <br />ur those prrsons direcU~ re+{amsibiv for gathering the information, the fnfurmation ~ <br />~• + <br />~ <br />1 <br /> <br />~ <br />, _~ <br /> snbmitled is, to the best of m. Anow ledge anJ Ix&f, tote, accurote, and compktr. <br />I um awar <br />that th <br />•+i <br />nifi <br />m <br />lti <br />f <br />b <br />i <br />i <br />f <br />l <br />i <br />f <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~ - <br />' <br />TYPED OR PRINTED <br />nnuurr.+Tes .rn runt w~rwrrn~r nr wuv . e <br />ere an <br />g <br />ca <br />pena <br />es <br />or su <br />m <br />tt <br />ng <br />a <br />n <br />ormat <br />+e <br />on. <br />irrctuding the p+nsihitiry of fine and imprisonment for knowing +i+dutiom, <br />..-.'`- - -.. ... OE?FICER OR AUTHORIZED AGENT AREA NUMBER <br />D YEAR MO DAY <br />AFTER trC?~L>r'~ ~ (:i^~'~: ~', 1 ~ ~;F,MF'!.. II <br />~FRF'llf,Mti7 <br />- T't115 Iti i7 ~-~1df2 ff?Cill <br />