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PERMITTEE NAME/ADDRESS Nnrludr Fati6tf :~'amr/l~Katinn if lhfftrnul <br />NAME . _ ~. i_. . <br />ADDRESS <br />~. i.'~~ rl n ;t <br />~.. Iti' ~ 1 T G.'7 <br />FACILITY ; 7LJh .x z .: i'') I`; ]. Iti <br />LOCATION ;,%~ ~ } ~.'D ~I4:_'4 <br />1 aPtlf'l'- ,,:,T7~, ?7T,'•!F P1Ai~AOfiR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMA) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY. YEAR O DAY <br />FROM TO <br />Form Approved. <br />pMB No- 2040-0004 <br />NOTE: Read Instructions trefore completing this form. <br />PARAMETER QUANTITY OR LOADING DUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX ALYSIS <br />A TYPE <br /> N <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />SAMPLE - ~ <br />~ is <br />% ~ <br />' • <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT ; ' ~ :; I~ i , .. <br /> SAMPLE - <br /> MEASUREMENT - ~ - - - <br /> <br /> PERMIT ', y. ~. ~ ,J. <br />s <br />. ' <br /> ~ , ~ ~.: i , , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT j I <br /> <br /> PERMIT <br />~ <br />~ .=+','t; <br />~ - <br />. <br /> REQUIREMENT <br /> SAMPLE <br />,/ _ <br /> MEASUREMENT <br /> ,- <br /> PERMIT . , :: - .~ ~ <br />~tv , <br /> REQUIREMENT <br /> SAMPLE <br />~ <br />~' <br /> MEASUREMENT ~ `'~ <br />' ~ <br /> - - ; <br />: ~ - <br /> PERMIT a :, :~ .r ~ ., . . <br />.. <br />30Ua A~.'C~ <br />' " REQUIREMENT <br /> SAMPLE <br />r <br />{ - MEASUREMENT '~ ~~-' ~ <br /> <br /> PERMIT ~ - <br />~~ <br />- • <br /> REQUIREMENT <br /> SAMPLE ~ <br /> MEASUREMENT ~'~ <br /> v x _r _ -.... - <br /> PERMR . vv i' t -, <br /> REQUIREMENT <br />MElTITLE PRINCIPAL EXECUTIVE OFFICER I ee•rtiry under penom e,r I°~ Ihal this deaumrnl and all altachmenls wrre TELEPHONE DATE <br />NA prepared undrr m) direrllon ar ,open-i+iort in uccortlattrr with u srstrm deigned <br /> to aesurr thin yuulifitd prnonnei properly galhrr and csaluate thr information ~- ~ <br /> <br />- ~ - - - suhmitted. Nusrd on m~ inquiry cA thr prrva, or Ix~nons who managr the system. <br />`~ <br />- - -- er.um duecUy respmsihlc !or gathrrinq thr information, the information <br />or them - <br /> p <br />lN <br />~ t _ <br />~ ~ ~~ ~ { e. <br />wbmitted is. to the hest eA ms knowledge and helirf. trvr, wcuralr. and comp SIGNATURE OF PRINCIPAL EXECUTIVE <br />' ~~t' ~ ~' ~ ~ ~•" ~ - I am aware that there arc signirtcmn prnaltic for+uhmitNnq false informat6ar. ORIZED AGENT <br />A AREA M <br />TYPED OR PRINTEb including the pu+sildlin of finr and imprisonment for Anu+sinq siedntions. OFFICER OR <br />UTH NUMBER YEAR O DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments nere~ <br />~Ic <br />.1C <br />tr, rttea~atn GZ=i77CZi1 L7r=~iiFl i r:1 <br /> <br />Thli is ~ 4-Part f'cXnl. PAGE DF <br />