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PERMITTEE NAMElADDRESS Natludr Faci4ry .ti'amr/l,orvtian if IhJfrrcul <br />NAME -- .:~~(' i ._ <br />ADDRESS I' <br />L}lyj?, :Jc~ <br />FACILITY HQR l r: i _c V i`1 1 i . ;.' •`; <br />LOCATION _ Ri ~ ;•; ~ ~ I q 2Li <br />} _laf~(-~?= Y}~11~ ~ i'I Iti~' I"4r~~l~Iv~~ <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. OAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br /> <br />/ -~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION }.}Q, FREQUENCY <br />OF SAMPLE <br /> EX SIS TYPE <br /> ANALY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ : s ,.. ., rx .~ .t ~_. -T~ ..:~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~:~.-: .~-tt„ .~ :~-~~~ •~ ~. rl_:: <br /> REQUIREMENT `-{~' T c "' ' ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '' •' ~ :~ " ,. x tr ~ -a+r ;< .. rst :. <br /> REQUIREMENT ~- ~~~ `> : t-i <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I <rnit~ anger penalty ntluw that thiv documem and all atWChmrnta were <br />prcparcd tmdrr my dir<•rtion or auq•nivinn In arordancr with a s~drm M- igned TELEPHONE DATE <br /> <br />to asacrr that yualificd prnonnel properly t,athrr and esaluate the infonnatinn _.c. <br />- . <br />_- _ . _,. ,_ _ _ _ <br />-~- - wbmitted. Based on m. inquiry of the person nr q•ru:ns who manure the swtcm. <br />or thane penems directly resgrnaiMr fur ><atherinR the information, the informatlott t ~ ~ _=~ ' <br />~ - ~ <br />-~ <br />- <br />-- <br /> t <br />b <br />t <br />d <br />l / ~ J ~/ <br />~ - <br />~ elie(. true, accura <br />e. an <br />a~mp <br />e <br />r. <br />submitkd is, to the In•+t cd my AnowledRr and SIGNATURE OF PRINCIPAL EXECUTIVE - <br />~ ~ <br />° <br />, 1 om aware that there are siytificam q~nultlev for whmittinp take inG:rmatioa. AREA <br /> em fur km»vin <br />violations <br />itrili <br />t f <br />d i <br />risc <br />i <br />cl <br />di <br />h OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR~RINTED K <br />e gws <br />ry n <br />tne an <br />mp <br />mm <br />n <br />u <br />ng t ODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />.. <br />This is a 4-part tOrnl. PAGE OF <br />