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PERMITTEE NAMElADDRESS!lnclade F'acrliti.~'amr/loc•otinn if I1;ffrrrnU <br />NAME <br />ADDRESS ~ `'•~~iL <br />• ~~9 <br />CLj 824~~~ <br />FACILm ;-fC;F I ZI~ftV F1IN~ <br />LOCATION _H t~ p >,~ 2 4c4 <br />4 Qhll'1" LlATII~. MTf41F MAP!A^rR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEA M DAY <br />FROM TO <br />Form Approvetl. <br />pMB No. 2040-OOpa <br />SR tE ~ I .dc DRi~iG TR I E ~O G AL.AM <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 I ;c .. , _ •; 1_ : ,. = f? ~ -. <br /> REQUIREMENT .-:•'IJr~ ?,VC7 Gr"+ILY MX <br /> SAMPLE ~ _ <br />r <br /> MEASUREMENTI i .. . ' <br /> PERMIT r , <br /> REQUIREMENT _,i.;`Llri :,'-'i:• i)AIi. 'r t•i: <br /> SAMPLE J _ _ <br /> MEASUREMENT i f ' <br /> <br /> PERMIT ;,..~ ~..,L,i z K . r ~ yt., ;. <br /> REQUIREMENT '~ i i. -'~ - <br /> SAMPLE • <br />' <br />~ <br /> MEASUREMENT '- -l ~= c` ~ <br /> PERMIT ,: ~y";I.at-r :a x-f ~~t•;F ._ ;Y ~ _ <br /> REQUIREMENT ~Gi)A AVis t}!~I! <br /> SAMPLE <br />_., .i ; .. _ MEASUREMENT <br /> PERMIT ... ;: ~ ~ #~ •:- 'r <br /> REQUIREMENT i~IC+ L)AIi_Y ~'In - ~~ <br /> SAMPLE ~` <br /> MEASUREMENT -- /~ <br /> PERMIT ~ = .. ., _, <br /> REQUIREMENT li` DAILY ~-1X <br /> SAMPLE r <br /> ~ h ~ ~ ~ <br /> MEASUREMENT <br /> PERMIT r ~ .:+ :~ .. . F ~- t. *c ~ . . <br />" <br /> .REQUIREMENT ~iFriA AVG DAILY t~'-r ~ <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER 1 crrhry under penalty of law that this di~tmenl and all aun-hmem+ were TELEPHONE DATE <br /> prepared under m~ direction ur wprnisiun in accordance with a system designetf <br />- <br />. --- lu assure tlwt yualifird pervmnel pnyterll gather amt rs alurte the information - - - - <br />- -. _!.- whmincd. Razed on m~ inyuin~ to the person or per+nm who mana>Ze ihr system. <br />~ <br /> or Ihixe prrvms diresll~ resprm+ihk fur yatherir~ the information, the Infwrnratirm ~ ~ - - -~ _. _ ~ ~ <br />~ ', <br />- ~ suhmitt d is, to the br+t of my 4nuwledgr and Mlkf, troy. accurate. amt cumpktr. <br />SIGNATURE OF PRINCIPAL EXECUTIVE 1 '' ~ ~ ~ - ~ ,}~ j <br />- . _ ~ ~ <br />- <br /> 1 am aware that there are signlfkvnl penalties for+ubmittinR Grl+e infurmat8ati <br />isunmrnt fur knowin <br />violation. <br />ibilit <br />a <br />d i <br />i <br />di <br />h <br />r t OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED g <br />. <br />s o <br />int <br />n <br />mpr <br />im <br />u <br />ng t <br />e po++ ~ D <br />L:UMMtfVIJ AMU tAYLHIVHIIVt`I Vr NIYT YIV LNIIVIYJ (/7CIC/CI1{iC 0/I O(raVlrrrro/rra rear o/ <br />rFd F._ -9'c'i.!-. P..v sS;~ F'r2vc7~ ~~_..- ~ ~. _ _-, <br />)QO.9 / L`j7tiS l5.a =1-Past 10[lll. PAGE OF <br />