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PERMITTEE NAME/ADDRESSllndedr Fecilgr 1'ome•//„nniun rt UrJ,4rnlr~ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS _ ~ .i <br />$~JX F,?' PERMIT NUMBER DISCHARGE NUMBER <br />7E*d <br />FACILm ;_~; n t•i I P•iE (. ~~i'ir MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION 1F ~ FROM TO <br />Y K.AF'.', RECLA' ..; : '. ri`J 1'~ `:, •Irt <br />Form Approved. <br />OMB No. 2040.OW4 <br />a. ~ <br />(SUBR JC) <br />~ - 1= znrA~ <br />D5CNG TU ;RID/i~RASSY t,F~E <br />NOTE: Read Instructions before comDletinct this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />E <br /> EX ANALYSIS TYP <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - I <br /> MEASUREMENT / i - <br /> , <br /> PERMIT <br /> REQUIREMENT ^~ ; <br /> SAMPLE <br />MEASUREMENT ~~ <br /> <br />" <br /> PERMIT "E_ inn. t , <br /> REQUIREMENT <br /> SAMPLE <br />r • <br /> MEASUREMENT .. <br /> PERMIT <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT ~ ."~ <br /> PERMIT ~ ~ : ;- : - - - <br /> REQUIREMENT <br /> SAMPLE (~ - - <br />/. __^. ~ : _ i ~ ; i - ~ MEASUREMENT ~ i ~ ~ <br />_. U <br /> PERMIT .. ~ .. ~_ , <br /> REQUIREMENT /~, .`J 'r _-1 ,;` <br /> SAMPLE l <br />~ <br />r <br /> MEASUREMENT ~ ~ <br />J ~% ~ <br /> PERMIT -: r . ._r-~ <br /> REQUIREMENT - ~ _ • - . <br /> SAMPLE <br /> <br />MEASUREMENT _ <br /> <br />_~t <br /> PERMIT ,.. K. ~;.. .. _... ~. ~.: <br /> REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I rertiry nndrr (lenau~ :Ilmw mal Illi+dlKllmem and ou nuurhmem+»erx <br />d <br />d TELEPHONE DATE <br /> prepare <br />undrr m. <br />irniion ur +uprni+inn in accordalx•e »ith ~ +)+U•In dr~i>;Ilyd <br /> i„ .r..ure Ihul yunlified pcrwnnd pruperl7 ¢alher and e+oluxlr Ihr informutlan ' <br /> .uhmillvd. Rued on m~ inyuin or Ihr prrvm ur prrwn+ who munalte the xrstem, r <br /> or Ihn+r pernnln dirrctl~ rtHpm+ihlr for g:U herin); Ihr infwrmatilm. the ink,rnulUon ~ -I - -j <br /> +uhmitlad is, In the he+l n( m. An,l»IedYe and tlrlief, trur. w'ruralr, and armplele. . . ~ ~ <br />1 <br /> I am a»are Ihal Ihrre arr+i>:nifwam <br />rnallie+ Glr wbmitlin <br />f <br />l+ <br />I <br />f <br />r <br />ull SIGN URE OF PRINCIPAL EXECUTIVE ' <br />TYPED OR PRINTED p <br />k <br />a <br />c <br />n <br />o <br />m <br />oll. <br />imludintt the pn+ihilll~ of fine end impri+anmrnl for Anu»inK linlwiom, OFkICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MQ DAY <br />V VIII IYICI\IJ KI\V GAC"LMI\MIIV1~ Vr MI\1 YIVLN IIVI\J IIICIC/ClI1rC All AIIAGl1//ICl/IJ //Cl CI <br />Tp cI.,/FRiT SLIT', ;F.~~T TQ S~`..)RDE~~! DF °P.f'?f'1F' Tn! T ~ .:? [1Tt_ Q, <br />EPA Form 332p-t (Rev. 3J99) Previous editions may Ge used ~liti i5 a =~-dart fnfrll. PAGE ~OF <br />