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PERMITTEE NAME/ADDRESS rlecfudr Facility ~'atttdlnration iJDi/farntl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D RJ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION (~Q, <br />EX FREQUENCY <br />DF <br />NaLYSIS SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS a <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 /> 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 />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER l sY'niQ undrr prnaln of Inw that thi, doeument and all utwchmcot+werr <br />prepared undrr m~ direction or supeni,iun In nrcordance w-ithr systrm desi>;ned TELEPHONE DATE <br /> to u wre thm yualifird prrwnnrl pruperh father and cvuluulr the information <br />suhmitird. Ba,ed on mr inquire td the person or perwns who mannl;e thr ,~ stem, <br />responsibir for Pptherin~ the in/nrmutlon. the information <br />u <br />awns directl <br />lh~r <br />a <br /> p <br />y <br />r <br />. <br />submilt,d is, to the bexl ~>( my knowtrdge and belkf. trvr, accurate. and compute. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am aware that them are signitkant prnultic, fur submittinK falx• information. <br />AGENT <br />TH <br />RI AREA <br />TYPED OR PRINTED includinK thr pnnsibilih of fine and impriammcm for Am,win>r ,iodations. OFFICER OR AU <br />ZED <br />O NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />EP4 Fprm 332G~1 iRev 3'99 Provin:.a ed;tr~~ns rnd~V ^_ ..__~. ' <br />