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PERMITTEE NAME/ADDRESS rlnriudr F'arifiry ,Vamr//irration iJINJfrrnttl <br />NAME ' . <br />ADDRESS '' `-- <br />FACILITY i-±J"t ~ 7 .Ji+l Ni I ivE <br />LOCATION - H ~~ Q 8 j ~j~4 <br />kt~IC: E ~JF;UE, i'f IhiE. MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form : _ .. ... <br />OMB fac ~ii40~000ti <br />HRt71dIC WET TESTIr~IG FGRv? J r=, <br />/~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, 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 ;` I; ` ` ~ , `- ~~~;:~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - .. - . -- . ,,. ., .. .. ... . ,... <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT .. •S -.. .- ~t,' i~ ~~ ~ t'. l . ;. ,. it ..~ ,: , L <br /> REQUIREMENT • ~ "' <br /> SAMPLE • <br /> MEASUREMENT <br /> PERMIT s ,. ~ it ..... .. L , _ <br /> REQUIREMENT <br /> SAMPLE <br />_.~i-c: ~ . , •. `':'. - MEASUREMENT <br />- `-+ PERMIT ....~ ~- :F ~... .. .. _~ . . _ _:, _ <br /> REQUIREMENT -` '' ` ' `~ i i .;, .. • <br /> SAMPLE • <br />'- `!``'~'~' - ' MEASUREMENT <br /> PERMIT ,- ,. -. ,.. _ ,. ,. .. _ <br />- - REQUIREMENT 1'~N VALVi- <br /> SAMPLE • <br />_ <br />'~ MEASUREMENT <br /> PERMIT - ,. , . ... -..~ <br /> REQUIREMENT - •- <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I +•rrtir+ under p•nalt~ of law thm thi+d,KUment aml au uttachment+ wrrr <br />ith <br />d <br />d <br />di <br />tl <br />i <br />i <br />d <br />d <br />i <br />d _ <br />- TELEPHONE DATE <br /> ance w <br />a +~aiem <br />Rnr <br />prepare <br />utt <br />rr m~ <br />ra <br />on or suprr+ <br />sion <br />n accor <br />es _ r =_~, <br /> to ivure that yuailtied pt•rwnnrl properh Rather and e+aluatr tlu• inforn,utian <br /> wtrmiatd. Rued on m+ inyuin ,d the pcrstm ur privm+ who ,mnaRc lbe cysam. - -> <br />~ <br />~ <br />- ~' - " -- ' or those person, directh respun+iWe for gathering the infurmatlon. the inrormutwn ': <br />-' <br />- <br /> <br />-- <br />suhmitted is <br />w the t,e+t of m+ kmrwkdge and be1Mf <br />true <br />xcurute <br />and rompkte <br />~ ~ ~ _ <br />_^ , <br />, <br />. <br />, <br />. <br />i SIGNATURE OFFRINCIPAL EXECUTIVE • <br /> <br />• TYPED ~ PRINTED I am uwurc that there arc+ignifkum prnaltin for suhmitting fubr informat <br />an. <br />including the po+sibiliry of finr and impri on,m•m for knowing+i,dutions <br />OFFICER OR AUTHORIZED AGENT AREA <br />D NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND tXYLAnA l wN ur Arv Y v1vLA I wrvs IHererence an arracnmertrs Here/ <br />_ I~DIJR <br /> <br />'Phis is a ~-fan form. PAGE of <br />