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PERMITTEE NAME/ADDRESS rlrrdudr F'atiliry .~'amr/Citation if INJ/nantl <br />NAME <br />ADDRESS - -- - - <br />t; ~ Y <br />CC •`? 1z~c <br />FACILITY „ ; ~:;_. P_ r•' I lyi ~ C'•fitL LOADUI,' t'. <br />LOCATION ~?EPJCt' GCI di2cts <br />If74^. F' tJ r'ts7?FFt~:lIV, C~EP~' "7CyR. <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 />qMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />N0. FREQUENCY <br /> <br />of <br />SAMPLE <br /> EX Y TYPE <br /> ANAL <br />SIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> ,, <br />- - <br /> PERMIT -. r .~ :.- t , ;"ICi'.,,.~-I-, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -~.r_: ;fi ~ _ ... ;a .. -. .. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> : ~ < <br />r <br /> PERMIT ~ ...~ _ ~ , <br />. ~ <br /> REQUIREMENT <br /> SAMPLE <br />r? . - MEASUREMENT <br />~ <br />r` <br />PERMIT , , <br />I <br />` <br />... <br /> <br />L.. - , << ~ <br />_ <br /> REQUIREMENT t:. .• •. <br />: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '~' , . _ ~ .--. _ . ~. <br /> REQUIREMENT r I~;_ T riF, <br /> SAMPLE ~. <br />' <br /> MEASUREMENT ' <br />~ <br /> PERMIT ~ ~. <br /> REQUIREMENT / <br /> SAMPLE <br />J <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certin under prnultr ..f lu,a Ihnl this document and all utGrhna•nG aeerc <br />en~isi,m in accordance With a+!stem dr+i¢nrd <br />dinrtion or w <br />re <br />anvl nnder m TELEPHONE GATE <br /> <br />A <br />1 <br />I p <br />p <br />! <br />p <br />nnlifird p•rwnmd yruyerlc ¢alher and evulwttr thr infurmrtion <br />In u+surr that __ _ <br />~ % ' <br />~ r^~ <br />- - ~- _ / <br />I <br />~ <br />~ <br />t`t 1 ` ~ t- N <br />~' ~ <br />~' ( y <br />submittal. Bused ,nt m! iuyuiry or the prrum .,r pers,m+ who mana¢e the s!stem. I <br />t s <br />f ;% ; <br />l I <br />~~ <br />~„ <br />_ <br />or thou prr.unc directly re.ponsihlc for ¢athrrin¢ the infornwtion, the inrarmuti~m ~ <br />( <br />$~~ <br />~ - / <br />7 'w l~ ~ 7~~ t~ ~ f <br />r/ ~ <br />r <br />^, '~ <br />n 5 <br />/ <br /> t <br />rulr <br />a <br />d com <br />kl <br />h <br />k <br />l <br />d <br />d h <br />li <br />r l t ~ _ <br />~ <br />i <br />~ ~ C <br />_ (- . <br />rtre, anu <br />. <br />n <br />p <br />r. <br />+uhmittrd is. n: the <br />aws of m! <br />twx <br />e <br />¢e an <br />o <br />e SIGNATURE OF PRINCIPAL EXECUTIVE <br />~ <br />, 1 am uw urr that there arc +if;nificnnt penultiar rot suhminin¢ later inrurmalkm, <br />i <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED olatiotut. <br />imiudin¢ tM• qn+ibilih of fine and imprrnaxtmm~t rot knnwin¢ r D <br />GUMMEN~ti ANU t><r~nAllvly yr HnT VIVLHIIVIVJ Inerert:rrce an nuacnntanta ttrrrl <br />,~ <br />EP.4 Form 332G-; .Rev :if~ F ,.n..,.. r, .: -a, .- ._-. 1111~ I< ;I ~-hall i;:Clli <br />