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PERMITTEE NAMElADDRESS Ilneludr F'oriGls.Yame/Inratinn if11iJ/rrrntt NA710NAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />' PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY ,' it_I;~ -; ;_;~~ ~ I•i .i I'. ;. YEAR MO DAY YEAR MO DAY <br />LOCATION _ (a ~ Q ~ FROM TO <br />LFt+J~ - c: WADS, `r-i T NF t•iAriAC, <br />5Fc ", r12 NE TfF11;~~ <br />Form Approved. <br />OMB No. 2040.0004 <br />~f'Jl ~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER DUANTTTY OR LOADING DUALITY OR CONCENTRATION <br />NO. FREQUENCY <br /> <br />OF <br />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 />-• <br />t <br />'~ - <br />, -, : <br />: <br /> REDUIREMENT i { , . .. , ti <br />t <br />~ ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT ' ~~~ ' ~ _ <br /> SAMPLE <br />tit;:. MEASUREMENT <br /> ~ ..: ~, <br />~ PERMIT --~ •. ,. ... <br /> REDUIREMENT `t ~' ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : , -, .fi ~ . _ , . ~ -: ,, -• _• , <br /> ~ ;.. G,,, ;- , I L.. Y ~ , <br /> REDUIREMENT <br /> SAMPLE ~ . - _ <br /> MEASUREMENT <br /> PERMIT ~ .. -. ... . ,. .. J ~. ~- r:~.;, ., <br /> REDUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT `t ' ~ -,- - ..~ -. _ .. , .. - - , <br /> REDUIREMENT : ~t~' . , <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 rrrtiq under pennih of law that thi+d~rumrnt and yll u/tachmcnL. were TELEPHONE DATE <br /> preprred under m~ dirntiun or suprr+9+ian in urrordarce with a .stem designed - -• ~ _ <br /> to assure that yualiried per+tmnel pniperil yythrr and e+uluatr the infurmwtiun <br />- ---- ----- --- - - +uhmit0.d. Ruled on m) inquiry u1 the perw~n or persons who mnna>Zr the +I stem, .. <br /> ur those ItFnona dircrtl~ nwp,m+ihle /nr p,~thrrinX the informutieo. the intormatiwn <br />' <br />' d L <br />l <br />d a <br />klr <br />lk .t ~ r <br />~ <br />_ <br />, r. >.n <br />,mp <br />. <br />e <br />4 true. accufn <br />+uhmitted b, In the best wf m7 Anuwiedge wn SIGNATURE OF PRINCIPAL EXECUTIVE <br />' I am aware that there are vignirK•xm pcnullies fur suhmilling fa/+e infurmotion• AREA <br /> +iolations <br />tl i <br />risonment fur Lnuwin <br />tibfli <br />d f <br />u <br />h OFFICER OR AUTHORIZED AGENT NUMBER YEAR MD DAY <br />• TYPED OR PRWTED g <br />p t <br />ine <br />n <br />mp <br />inrludinK t <br />e p.+ D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all a[tacnmenrs nere~ <br />., <br />Thfs is a 4-Dart f(Ntn. PAGE OF <br />