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NAME TTEE NAME/ADDRESS ~Inrludr hu<'iith \uni. i.",u: ~,, :; (~:;;.n.u NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEt.1 rrNPDES) Q!~18 fV0 ~G4u 00G•S <br />DISCHARGE MONITORING REPORT (DMR) :: +OR <br />ADDRESS ~~ NEJ!Z i :: ;f,)$R ~ .-I <br />:j. rjQ~ _.~;~, PERMIT NUMBER DISCHARGE NUMBER -' r~' ".._ ?t{WT~f` <br />'j.~LA _. ... _ -. <br />"- "~' ~'` MONITORING PERIOD <br />FACILITY ;,F ;-.~0~ ; Z Gt+i i"E I i~fE YEAR MO DAY YEAR MO DAY <br />LOCATION +~'LA CO ~- c;;-_ ~• FROM TO <br />i_ANC~ irtAi'iF. M i IdF T•IAAtA~~F:* NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION (~Q, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE . ~ <br /> MEASUREMENT: <br />i /> v ~~ `~} ~ <br /> PERMIT - - K ~ .: . r-. ~ , .. ,.. <br /> REQUIREMENT ~ ~ ODA AVG ,: ~ ~ ~•Ir~;.~ <br /> SAMPLE <br /> MEASUREMENTI <br /> PERMIT --~ R I :_ ~ <br /> REQUIREMENT ":/-ilJ r-+ A~r`:~r rJA I L_'. <br /> SAMPLE ~ -~, ~ r---" , - ~jt <br /> EMENT ~ - ~ <br /> MEASUR <br /> PERMIT i~. r ~.r'ur•: ; <br /> REQUIREMENT :':;Dr=+ As/~~ ?7F; T i ' <br /> SAMPLE -`;, v ~ <br /> MEASUREMENT ' <br /> PERMIT 9t###iF-~ ... ' #~sc ;., _r <br /> REQUIREMENT -~(: D/; • . , Lr~ I E-. •~• i•1 <br /> SAMPLE <br />.~. ~_ ' ~ <br />! ~ <br />'` <br />~_~ -. ~ MEASUREMENT <br />':? : - , "' PERMIT ... ~• ~ , <br />" REQUIREMENT 30D~s A~`;= ~AII__Y ' <br /> SAMPLE /} q i ~ • ~ - <br /> MEASUREMENT I <br /> PERMIT - t ~ ~• ~ ~ • <br /> REQUIREMENT ;i~DA AVG %~r1?i. i'1C:~i'.iT` <br /> SAMPLE Lf I <br /> MEASUREMENT ~ ~ <br /> PERMIT - _ , r.. .... tC - .... _ .a <br /> REQUIREMENT -.. '..•,; A~~G • . ~, ~ i-_ . i _ ,~,; i <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrlifi under prnalh wt law mat mi+dnrnmem and all wwchmerls were <br />i <br />i <br />with <br />+le <br />i <br />ed <br />d <br />d <br />di <br />i <br />f <br />d <br />d _ <br />, TELEPHONE DATE <br /> cr rt~~ <br />rccl <br />nn nr wpcr. <br />n wcur <br />ancr <br />a .~ <br />m <br />e+ <br />¢n <br />prcparc <br />nn <br />. <br />on ~~_- <br />j <br /> io awwre that yualiffed pervmnrl pnrperl~ lylhrr and e~aluale the information <br />~ <br />----~-- - - - - -- <br />~ +ubmitlal. Raed on me inyain of the perwn ur prraam wbu manage the .~+ta•m. <br />or lhost perwm diirctlr respon.i6le fur ygalbcring the information. the intormaton ~ <br />- <br />~~` ~f f <br />_ <br />_ <br />• - In the Ixw ut nn knawiedge and Mllet <br />accurole, and complete <br />suhmi¢rd i+ <br />true ~ ~ <br />' ` ~~ ~ ~ '; ~~ <br />' . <br />, <br />. <br />f <br />i <br />f <br />i <br />- SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED ormat <br />I am aware that them are +ignit <br />avnl penaltin fur whmitling <br />al.e <br />n <br />on. <br />including the gn+ibiliq of fins a~a1 impriummem fur knowing ci.dalion,. <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />GVMmtrv I J gryU txrt_falvra l lulu yr suv r vlv~w l vulva Inrrrrrrrcr en euacnrrrrrrw nr/r~ <br />~: q '~ s~;:u ~ ~~: _. ~ i F'r. :sus h.:nr; -r,; - I I.i~ ., ,c ._ I~:~f! luf:li. °AGE OF <br />