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PERMITTEE NAMElADDRESS dndudr Foriifity .'~'ontr/l.oraion iJfhJJrrcml NATIONAL POLLUTANT DISCHARGE EUMtNATION SYSTEM ((NPDES) <br />NAME , DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ~..ii~r~ . lUi~ Iii.; <br />B7 F ,5~8 PERMIT NUMBER DISCHARGE NUMBER <br />'-A MONITORING PERIOD <br />FACILITY f,dLt~1 ~~~ I Z+~N ~ <br />YEAR MO DAY YEAR MO DAY <br />LOCATION -• ~~ FROM TO - <br />w~.nr yin r.-~~. <br />Form Approved. <br />OMB No. 2040-0004 <br />iR°:M I NE DR(VG TR I l~ TO ~'U-T TL,IF <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION I~Q, <br /> <br />EX FREQUENCY <br />of <br />NALYSIS SAMPLE <br />TYPE <br /> A <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />;_ SAMPLE I ~ <br /> MEASUREMENT <br /> t <br />?• <br /> PERMIT <br />REQUIREMENT <br />SAMPLE _ ~. ~' i.i~-~ T <br />- iUG ;3it 1 <br />~ P1ri '. <br />_ , . <br />t`i; r= <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT • < E F' i~= -, <br />iiFt I t . ` <br />i•: <br /> SAMPLE <br />• ~-; MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />- ~- x ~: ~ <br />•.. ~; x - <br />n>=PUR-f <br />3CUA f~`:'G <br />REPOf~T <br />[iA j.l_ r I.1X <br />_ ~a~-_ f <br />~ ~ - _ <br /> SAMPLE <br /> MEASUREMENT <br /> - • : <br />~ I _r <br /> PERMIT ; ~- <br />REQUIREMENT ~ , <br />:y~~''n . <br />;i ; <br />f'{~. ~ , <br />; ~ , <br />{'ifi{'ti I'- , <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 />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I trnf~ under prnulry of law that thi+dawmrnt and uII uttac•hmrnL+were TELEPHONE <br />prrpnred under m~ direction or supeni+ion in acmnlancr with a +~+Irm designed DATE <br />to as+urr that yuulifird prrwnnrl proprrl~ gather and e+aluatr the infwmatiuo. _ <br />- <br />_ - wbmianl. Byrd on m~ inyufry of the perx~n ur pervm+ who rnunaAe the .y+tem. .:~. ~ - ' <br />~ <br />- /,' <br />nr lhu+e perwn+ dinrtl~ re+p~nsihk for galhrring the inh,rmnlion. the information ~ <br />, wbmittrd is, to the hest of m~ Anow Icd rand hrUel. Irur. ucrurace, and mm k1a I i - ~• <br />1 j <br />SIGNATURE OF PRINCIPAL EXECUTIVE / -' ., - / <br />/ <br />t 1 am awurc thnt tlw•rr urr significant penalties Gar wiltmitting fulx information, T <br />R <br />A AREA <br />TYPED OR PRINT D Including the prx+itrilih ur rinr and imprisonmrm fur Ltwrwing +idminn+. IZED <br />GEN <br />OFFICER OR AUTHO NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 33?0-1 iRec :igy ~'°Uiu~S ed~~bon< r^a7 tr -.-_ ~ I!L i~ a ~ •,lfi I(;I-I!~. <br />