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PERMITTEE NAMElADDRESS ilncfudc Facilifr .\ame/lorafion iJIAJJ'errnf <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2U40-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX ALYSIS TYPE <br /> AN <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT • <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER l certif. under penulh id law that chic drxument and all auachmentc Mere TELEPHONE DATE <br /> prrparrd under m~ diredian ur wpenidnn in acrurdxnce with x ccctem drei>ttxd <br /> to acwrr thus gtwiifird perwnnel properi~ gatfirr xnd rc xluxte the informntian <br />_ - ~ cutunhlcd. Rased on my inquiry of the pt•rwn ar pr•nanc wfio manage Ihr saem. <br /> cnanc diret•tly rcpmcihle for ¢athering the infurmrtion, the infxrnwlion <br />or thuce <br /> p <br />wfimitted i , to the Acct of me knuwleditc and hrlief. trur. accurate. and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that then arr cignifirmt peaaltiec for whmiuiny, futx ioformatinn• <br />EN AREA <br /> win <br />dalatianc <br />r <br />t fa <br />h <br />l <br />f fi <br />d i <br />i T <br />OFFICER OR AUTHORIZED AG D NUMBER YEAR MO DAY <br />TYPED OR PRINTED g <br />. <br />mpr <br />wmm <br />n <br />r <br />tw <br />ittcludin~ the pmcibi <br />it~ o <br />ne an <br />COMMENTS AND EXPLANATION OF ANY <br />(Reference all attachments here) <br />EPA _ <br />