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PERMITTEE NAME/ADORESS tlnr7ade F'arililt .~aete/Ltcation if Utffrrrnrl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME ;; ~~ ; DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ~ ~ ''- rt ~ ~~~ <br />~ L{Q~ b~ PERMIT NUMBER DISCHARGE NUMBER <br />~- L l-t MONITORING PERIOD <br />FACILITY ;~ HDiZI2;3iV r'' YEAR MO DAY YEAR M DAY <br />LOCATION irLA FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />R3.M I Nc DR ga ~ TR i I3 TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />of SAMPLE <br /> <br />EX <br />SIS TYPE <br /> ANALY <br /> I AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />• SAMPLE <br /> MEASUREMENT] <br /> ' i ~~ <br />~ <br /> PERMIT ~ ,: .,:.. ;:~L:I <br />tJFi I r ~ <br />' , <br /> REQUIREMENT -, r•: , AV s !1X h~JN <br />F <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~'::r x-!~ ~ ~.-=. _; .~.. `•. - :. I ~ t . t •-t :~ <br /> REQUIREMENT '~i?A A~~:: '~?FIIL'r t-iX <br /> SAMPLE <br /> MEASUREMENT <br />,, <br />' PERMIT - ,2 ,. _ ~ <br />" ,,. '_ <br /> REQUIREMENT 3GE"it4 ;a4'i• Li.a I C_Y <br />~'' ~ ; <br />~ r <br /> SAMPLE <br />•~ MEASUREMENT ~ <br />- <br />r ~~ PERMIT ~ ~< 7 :.~ - _ r , ~r ~ - . <br /> REQUIREMENT 30L''~ AVG ': ~ L1` , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT I - ..: ,i r: r , ., <br />.. ~ .. <br /> REQUIREMENT 3 ;ODA ;~,.. r-~ ~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT if & s~.,.: }.;t .:t ; ,c ., .: ,{ .~ : ,r ' ,. . _ - .. I ... ., ~ .._, <br /> REQUIREMENT =~~ ' i~ i~P~ ` L 'Y '; ' "'I' ' <br /> SAMPLE • <br /> MEASUREMENTI <br />PERMIT , :<.; .: h .r - - - r~ t_ ter- ~ .,., •?•.. __. <br />REQUIREMENT ~ ` :aDA [a `. _ i:~ r•, ; ~. `r ; i ;< MrJNT t <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ceniq under prrtahc ~d law that thin d,wumrnt and all atlwhmrnta weer TELEPHONE DATE <br />prcparcd under ma directiow or wpcrsision in wecordnm•e wlth n spdrm designed - <br />tu assure thnt qualified prrwnnel prviprrl~ gather and rsuluate the infortnatiun - <br />__ _ _- .ubmiurd. Raced on m~ inquire d the penan or prrcnna who manage tlfr arstem. i <br />~ ~ <br />ur IA~nr prnoas dirrdl~ responsible tnr gathering the information, the Informntiun ~ "- ` <br />_ <br />'~ <br />i' <br />' ` ~~ ~ , <br />-`~ ~ ~ <br />i <br />~ ~l, <br />' submitted n, w the beet of m~ knowkdgr and belief, true. uarutvte, and complete. _ <br />SIGNATURE OF PRINCIPAL EXECUTIVE - <br />/ -- ~ <br />-~ ~ I am aware tbat there arc signi6ram prnaltia_ fur submitting fnlsr inG~rmuG,m. AR <br />E <br />A <br /> iw <br />t /n <br />knowin <br />ai~datiuaa <br />ibility <br />f f <br />d i <br />l <br />di <br />th OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED g <br />. <br />o <br />ine an <br />mpr <br />mmen <br />r <br />Inc <br />u <br />nk <br />e poss D <br />O <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />FPA Form 33;,~ o, f~~•. ~. ~ - ._ PAGE OF-- <br />0-t (Rev 39_ i~!Il~ i :~ ~ ;~:+rl lur~i; <br />