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PER MIITEE NAM E/ADDRESS Ilnrlade Facility ,4'amdGxatiun iJ IliJJrrrnt t <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br /> <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 2040-0004 <br />NOTE: Read Instructions before completing this form, <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - - <br /> MEASUREMENT~ <br /> PERMIT <br />~ <br /> REQUIREMENT t <br /> SAMPLE <br /> MEASUREMENTI <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 . a' ~ ' <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElf1TLE PRINCIPAL EXECUTIVE OFFICER l recur, ander penalt> .,r tan Thal this document amt odl atWai~menb wrrc <br />d TELEPHONE DATE <br /> prepared under m~ direction or auprnision in accordance wish a system designe <br /> lu unsurr tluu qualifird prrmnnrl prnpertr Bother and rs aluutr ihr informatlem <br /> suhmittrd. Nased on m~ inquin of the pcrvm or prnuns who manage the systrm. <br /> or th~nr pervms dirrcth mpamsihir fur gathering the information, the infurmatNm <br /> submitlyd Fn, to thr hoi ..f m~ knowledge and txlief. tnu. uca'uratc, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am uwarr that lhrrr arc signifkvm penalties for.ubmittinq false information. <br />f <br />d <br />ti <br />h <br />ihili <br />f f <br />d i <br />i <br />k <br />i <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED now <br />ng s <br />nm, <br />including t <br />r puxs <br />lr o <br />ine an <br />mpr <br />nment <br />or <br />~ <br />a <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />PAGE CF <br />.I I-:1. i~ _ ~+_1- Ii i11I~. <br />