Laserfiche WebLink
PERMITTEE NAME/ADDRESS ~lndudr FacJ/ry h'amrllwlcurinn if Diffrrrn0 <br />NAME <br />ADDRESS - `-• = "tom <br />..7. BDX <br />~.~I~SF+IGi~D SCI _ ~~c <br />FAClurv i~_1THF I FL:~ t ; i -•~_ <br />LOCATION - - -~;!~. <br />i <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 /> <br />J Ilt}1 ~t <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION I~Q, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNRS <br /> SAMPLE " ' <br /> MEASUREMENT <br /> PERMIT ~ ~ I <br /> REQUIREMENT ~ "~l!f"! <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT • ## ~. ~ x K „ .. ;~. c, ~ t .,., _. , _ <br /> REQUIREMENT - i'' • I'i.X i•1©N'i'i- <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT •~ . ': .. .. <br /> REQUIREMENT - ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .: ... - <br /> REQUIREMENT A n'v' _; D r; '. L Y• h1'• ,-. ~ (3(` i 'f !-' <br /> SAMPLE '` • <br /> MEASUREMENT <br /> PERMIT - .< 3` ,, . - - _ <br /> REQUIREMENT - '' ' <br /> SAMPLE <br /> MEASUREMENT <br />1 <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE I/ <br /> MEASUREMENT ~J ' <br /> PERMIT r <br /> REQUIREMENT <br />NAMElTRLE PRINCIPAL EXECUTIVE OFFICER I rertif} under prn:Jls of law that thi+d,xumenl and all attachment. »rrr <br />d u <br />d <br />r m <br />di <br />•ti <br />w <br />r+isi <br />i <br />u <br />• <br />with <br />t <br />d <br />~ <br />d <br />i <br />d ~ <br />~ <br />F- TELEPHONE DATE <br />{~ I C 1 I M ( ~ A' <`• ,~ ~,J <br />' \ f~ / , v 'v '- prcpun <br />n <br />~ <br />nn ar <br />pe <br />nn <br />n acc <br />r <br />am <br />a y <br />em <br />gne <br />e <br />m <br />r <br />s <br />e <br />to a~ are 11wt yuuliried per.onncl pruperl~ Emher mat c+aluate tln• inG,rmation <br />+uh <br />itt <br />i <br />f th <br />t <br />d <br />B <br />d <br />i <br />»h <br />h i <br />) <br />~- ~r <br />'~~ - i ' per'-- - ~~ - ~- -_ -_.• <br />`/ ~ <br />'T-Q <br />I <br />~\ 7 <br /> <br />• ) <br />• m <br />. <br />nn tn~ <br />nyu <br />e penon or per~on+ <br />e +r+ <br />c <br />u.e <br />ry o <br />u manage t <br />em, <br />ur th,nr penun+dirreUy rssgmdMr fur l;atM•ring the infutmrti~ut. the infurmatinn , <br />- <br />~ <br />~ <br />Y <br />~ <br />j ~' ~ ~ .% C, T <br />• <br />~' <br />~~ ~ 't~ submitted is, to the belt ur nq Ann»i<dgr attd h<lirf, true, accurate, and nnnpktr. ~ C~ , .' <br />/ ~ ~ ~ ~ n <br />/ <br />t I atn aware that thcrc are significant penaltles fur suhmiuing false infnrmatioo SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED . <br />inchafing the p~x.ibility ..f fine and imprls:mmrnt fnr knowing ciulauun+. <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MQ <br />DAY <br />I:VMMCIV 1 J AIVIJ CRYLAIVA 1 tVIV Vr NIV T v(VLt- t (VIVJ (rYBIBr@r7t:e all H([aGrl/r1eRl5 ere/ef <br />1P I~.'ENT SVf3JECT i' <br />'175 14 8 -~-~3ft 1(rri71, PAGE OF <br />