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',; ~ AaPloveJ <br />PERMITTEE NAME/ADDRESS r,aiu~I /m;u;, ~,,,,,< l.,.,,;",,; :; I+il/~n,,:; r~anoraa~ Poiwiau! uiscrtaaGe =urair~anor~ st'sTeri ((NPDESJ b fJO. 204Q~(X104 <br />NAME DISCHARGE MONITORING REPORT (DMRJ <br />i <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER °^'• ~`~ T I <br />MONITORING PERIOD <br />FACILITY <br />YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />,. ,~ ;_1..t, 4 ~,;, ; ;,,,;: NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREt1UENCY <br /> <br />OF <br />SAMPLE <br /> EX ANALYSIS TYPE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ a _r <br />-j J-' <br />~ <br />~ <br />i' <br />t ~ <br />If`t~>i?~.1 <br /> MEASUREMENT <br /> <br /> PERMIT ~_ . <br />~, <br />,;, ,~,; ~ `'H <br /> REQUIREMENT ' ' <br /> SAMPLE -;_ r_ I ~ r~. = / : ~. - "',:ei-?, <br /> MEASUREMENT - <br /> <br /> a ~ ~~ ' <br /> REQUIREMENT <br /> SAMPLE I ! !, <br />i ~ - ! ' <br />~, L_4'-~ YS <br /> < ,. . . <br />. <br /> MEASUREMENT <br /> ' .~-~::, <br /> PERMIT `~ `~ ~ .!. _. <br /> REQUIREMENT <br /> SAMPLE ;j ' <br />'" J ". _ .. ~> _ _. ~ '~~`- <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE r1.~_ yI !~ _1~ '~,a~~~ <br /> MEASUREMENT <br /> <br /> ~ I L~AI Ll' tgppdT`! <br /> REQUIREMENT <br /> SAMPLE ~ ~ r ~ , ,\ 1 / 1 <br /> MEASUREMENT <br /> PERMIT .. ~ - - _ <br /> <br /> REQUIREMENT <br /> SAMPLE f~ ~: <br />i t l i <br />C <br />C~ <br />I I } <br />I ~ ` i ~ <br /> MEASUREMENT , Q, <br />G <br /> <br />PERMIT _,-,.._, ,.-, n. <br /> REQUIREMENT ;:', t'. ' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t errtih undrr prnah~ utlaw shut thi. d~r'unrcnt and all atulchlllenl. were <br />prep:IrlY1 Under nn dlrectr,M nr Wpera'ISNIn III aaa'nrd YllCe Mith D \)till'1n de.Igned i <br />-~ ~' <br />~ TELEPHONE DATE <br />'t k j . ' ''" ~ • * i- ` <br />` '_ - ~ to asmrc that glmli6ed prrzonnel pruperl~ gather xnd caahwlr Uce information <br />th <br />Ur <br />h 1 ~ ~~_ _ <br />i <br />l - <br />- n manage <br />e a~ <br />m. <br />whmiued. Ita>ed Im n1. inquiry of dm peruul ur perv~o. a. <br />omiMe fur gathering the in(ormuliun, the information <br />ur Ihrl <br />enum directly ro <br />~ ! <br />~ <br />• <br />%- <br />/ <br />.- <br />~~( <br />r <br />y }\ {' J- .~+i~~ p <br />.r p <br />~Uhm1I1tY11~. tl, 1111• ha'N of mr klroMleduc and hrlicf. true. accuralc. and amlpkte. <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~~ <br />..... <br />, J ~/ ! ,/ <br />, <br />`.-% '-i V ~ <br />`~ ` 1 am awarr that thrrc an~ .igniric-rm penaltir.. lur.ubmiltin>; lal.e information. R OR AUTHORIZED AGENT <br />OF <br />I ARpE NUMBER YEAR MO DAY <br />TYPED OR PRINTED including thr pncihilin of fine and impri~.mmem for knowing riulutitun. F <br />CE <br />I COMMENTS ANL! tJCYLArvMttvt~ yr r11~r •IVLMIIVIfJ irlclc.c.+..~ o.. a.•~..•••~•~-•~•~ •~~•-i <br />-1f2 PkFC.1i' rVLn -• SEE I. ;i. ~, PG. ~• FCtP. REQ:Ji~E~E~ITS. <br />Tlti~'i< a 4-part 111ru,. ~ncF of <br />EP4 rarm 3?20-~ Few ; ora~ Prc,. <br />