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PERMITTEE NAME/ADDRESS dnrlude FariGty,Yamdlotrttinn iJDt;/Jmnt) <br />NAME <br />ADDRESS ,... ~_ l1('a':.T. <br />ra7h <br />t: (7 8163` <br />FACILITY • - - <br />LOCATION ~ EN ~, Q 8I b3` <br />. r ~~~,f'I RECL_:;:-:R-I ION PIAIVAC`FR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY Y AR MO DAY <br />FROM TO <br />Form APProved. <br />OMB No. 204p-0004 <br />M a i~i _'i' ~.. • <br />(SIJ;3R . ~~, > <br />ft - FINaL. _ . <br />DSGHG TO 7RIB/~ftaBSY CREE'!~+ <br />Nf1TF• Rnari Inefr ~~;., h,,r,- .,i,.n..., fVslc ~., <br /> <br />PARAMETER <br />QUANTITY OR LOADING ___. __._ __. _. <br />QUALITY OR CONCENTRATION _ __... <br />NQ, r._-...~ _.--_ <br />FREQUENCY <br />OF -__.... <br />SAMPLE <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT I <br />1 '~ <br />j , <br />~-j <br />':'~ <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT i <br />~- <br />~ <br />~•J <br /> <br /> PERMIT <br />REQUIREMENT , <br />; <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 /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I +crtiry under penalty of low thin thi+d«umrnt and dl auachmenl> wrrc <br />pmpurcd under my direction nr wprn ision in accordance with u y+lem rksigned TELEPHONE DATE <br /> to us+ure that qualified prr+onnrl proprrt~ gather and es duatc the information <br />submitted. Rased on m+ inyuiry of the prrvm or persons who manage lbr sslem. <br />ur those persons dirrctll resp~n+iMc for gathering the Information, lbe information <br />_ - - <br /> <br />I <br /> <br />"`~ <br /> mhmitad r, lu the beU of m~ knowledge amt txdief, true. accurate, and eompltlr. <br />I nrn <br />w <br />Th <br />!h <br />SIGNA RE OF P <br />IP - l ~ <br />r/ <br /> a <br />are <br />al <br />ere arc signifkum prnahirs Lrc wbmitting false infornmWm. RINC <br />AL EXECUTIVE <br />TYPED OR PRINTED <br />CAMMENTS ONII FXPI GNOTIf~N l~F oNV vlnl including the p,xsihitih of fine and inyunonmenr Ga knowing +idations. <br />eTlnAlc ioaiere.,..., .,rt ..~~ ................ ~___~ OFRICER OR AUTHORIZED AGENT COEA NUMBER YEAR MO DAY <br />Ll~EC?ilai+l U~ I2 SAMPLrS, P~RP1ITTi/F _IIF <br />D. <br />_~_ _ ~ 1.1•,I, ~. :1 -'' r~;lrt f~r,,,. PAGE OF <br />