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PERMITTEE NAME/ADDRESS rlndude P'atilirs ~'omr/location if!)iffrrentl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />r, t? ~l <br />rltaraA~3ER <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 DAY <br />FROM TO <br />Form Approved. <br />OMB No. 204QOQp4 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br /> <br />of <br />SAMPLE <br /> EX TYPE <br /> aNALrsI$ <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~- <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> <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/TITLE PRINCIPAL EXECUTIVE OFFICER I certif> under penau> of law that Ihls document and all ottw-hment+ were TELEPHONE DATE <br /> prepared under m~ direction or .uprniaion in accordance with a system de-cipwd <br /> In asurr that ymdified prrmnnel prnprti}~ gather aml r. aluatr the information <br /> submitted. Baird on m. inquiry of the perwm ur persons who manage the s~stem. <br />- or Ihosr prnons directly resga~sible for gathering the information, the information <br /> submitted k, t„ the hest of mr km~wlydge and belief, true. accurate. end complete. $IGNATURE OF PRINCIPAL EXECUTIVE r <br /> 1 am aware that there arc+ignificant Ixnaltitc for wbmiuing fair informaton. <br />ri~A <br />s <br />t ! <br />k <br />wt <br />tio <br />l <br />di <br />h <br />ibiti <br />f f <br />d i <br />i <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED ng <br />ine an <br />mpr <br />sonmen <br />or <br />no <br />a <br />, <br />nc <br />u <br />ng t <br />e pos+ <br />ty o <br />n DE <br />COMMENTS AND EXPLANATION OF ANY <br />(Reference all attachments here) <br />EPA Form 332(5.1 (Rev. 3x39) Previous editions may be used. ' ~ t } Tlliti is ti ~-paTt fOCITl. <br />