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PERMITTEE NAMEIADDRESS b„iu f „d,ry ~,:,,:, f •; . t:, ~,:,::: varior~a~ vouuraaT riscitaf,Ge i=_umiraanor~ svs7en~ rrNPDES) Ut,AB ~JU. zoau-ocoa <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ~! ZQI~ i'II.' <br />_ iiOX bt".' PERMIT NUMBER DISCHARGE NUMBER • <br />FaclLmr _ ~ -;~~ I ~~ ,~.•, -- MONITORING PERIOD <br />_ YEAR MO DAY YEAR MO DAY <br />LOCATION ~:/L.A ': i.1 t' FROM TO <br />• L..APt~E kr•tL7k: °i; i~lc C-lAlvfibE. NOTE: Read Instructions before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :r . ,t•~• ri # .... i „ sr . ,....r ; <br />• REQUIREMENT - -~ .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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TfTLE PRINCIPAL EXECUTIVE OFFICER 1 certif. undrr pL•nult~ of law that this dLkvnu•nt and all utwchmrnt wrrr <br />d <br />l <br />Ai <br />~ <br />i <br />i <br />H <br />i TELEPHONE DATE <br /> prepurr <br />ula <br />rr m} <br />ra <br />nn ur caper. <br />, <br />ln <br />t <br />n accordance wilh a .. Nrm desiAlyd _ _ _ _ _ _ _ <br /> to awrr thus yllulifi d perNMlNi property glllher and eraluute tlK information <br />_ _ -_-- - -- <br />_ submitted. Raced nll nl. inquiry of the pel\an ar prl•,Ims who manuKr the ~yHL•m. ~ ' <br />_ or th,.~r pawns dinrih rrsgm,iMr for Katherilryt the infortmtion. the InfLlrmution <br />j ~•, ~. <br />~ ~ubmittrd i., w the bat Id m. knowledlte and hrlief. true, uccw'ate. al/d complete. ~~t <br />~ 1 am aMUrr ttmt ihrrr arc sry <br />•nificunl prnulties for suhmltting fakr information SIGNATURE OF PRINCIPAL EXECUTIVE . <br />'- <br />' <br /> <br />TYPED'OR PRINTED , <br />, <br />Indudln • thr u.,ibilih~ of finr uml im rnannlrm for know in cioWtions, <br />~. p p ' e OFFICER OR AUTHORIZED AGENT ARpA NUMBER YEAR MO DAY <br />VVIYII~I VI~1J MI\/ G/~r"LMI\MIIVI\ Vr MI\L YIVLMIIVI\J InCIG/CIILC tlll tlLLtlL:71/IICIIIJ /ICI C~ <br />?~lll_fR)= t;7ARTT~Ir i-1-t~9, IF Tt-Ii=RE IS IVCIT A STAY I?I <br />:,Ef= - <br />PAGE C <br />Ill< t~ a -1-(,;iii ti1llrl. <br />