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<br />~ PERMITTEE NAME/ADDRESS ilndtrdr f'ariGry Name/(nrnrion rf INQrrrali <br />NAME <br />ADDRESS .,t ~i]iV <br />'.3 . n O X 628 <br />!_A ; <br />FACILITY HC1R Z ZON M '. ~•w <br />LOCATION ,, A C O e <br />AfVC>` WARE, MIi•~F MANAQE <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 />OMB No. 204x0004 <br />M I NOt~ <br />c sul;r~ ~~; <br />F -~ FINAL MN rt~~ <br />SR&I"1INE DRNU Try T'J-r7l-~ I;Fr'aW <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT I .-. i ~. ~i7RT REf'4"~: ~ ;i.;. ~_. •.91::-: <br /> REQUIREMENT ;'~ AVG ~~; I4. '+` ^t~; '! ; <br /> SAMPLE ~ - <br />• MEASUREMENT <br /> PERMIT -, ... iii=l=JR'T ~~°~ft-. <br /> REQUIREMENT ~C)DF~ A`v'G :~/.I ~ "~` <br /> SAMPLE --- <br /> MEASUREMENT <br /> PERMIT ~ r.- ,* ~ , . RFF'OF7T REP R i_; <br /> REQUIREMENT ~•~:~I:A Avg: DA:I-.•= MX <br /> SAMPLE ~- ~' <br />•; MEASUREMENT <br /> PERMIT ~ ^ :: R c _ -t <br /> REQUIREMENT DP. i L.Y (•i'~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrtir) under pa•nulq of low that th[s document and adl attachmrnLs weer <br />iu <br />r <br />a <br />d <br />der m. di <br />erlG <br />si <br />i <br />d <br />• <br />i <br />h <br />d TELEPHONE DATE <br /> p <br />rp <br />rc <br />un <br />r <br />m nr wper <br />n <br />n rarur <br />w <br />s <br />nnn <br />t <br />a system <br />esigned <br /> to ocwrr that yualirird persunnd pnperl~ ~lhrr and ea aluatr the information - -~ <br />_-_._ _ _ whmittzd. Bwxd on m~ inquire ~d tltr person or prrwn who munaKr the ~~stem. 7 -~ ~ <br />I <br /> nr th,ne penons dirrcU~ rae-punsiblc fur gathering the information, tha• Information <br />.. -' submitted h, w the best rd m. Arwwiedgr and heliel• true, accurate, and complete. ~ ~ ~ • <br />' 1 am owur thot tha•ro are .ignificant prnrltfrs fur wbrwitlin <br />6e info <br />ation <br />f SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~ ~ ' <br />TYPED OR PRINTED g <br />a <br />rm <br />. <br />including the pussihilitr of fine and imprisonment fur kew,wing ~iolatiuns. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />CODE YEAR MO DAY <br />Incrcr crvcc mr artew uncnw rrcr c/ <br />_ .;-1 (Rev. 3199) P;~_. - .. i,: - i ~ ~ ,, .. Iitl~ <br />r --- <br />