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PERMITTEE NAME/ADDRESS ~Indudr Farilitf i\'amr//,oration iJ/hjJrmui <br />NAME _. L~-'_ <br />ADDRESS - - f't : ` <br />b~8 <br />~~O ~74~4 <br />FACILITY _ i . :. L~.lM1f M IP:E <br />LOCATION ~ C ~ ~ ~ !>}~ 4 <br />i_.4NCE WADE, t'4Ir+iE MAitilA6l"R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />DISCHARGE MONITORING REPORT (DMRJ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />- - SAMPLE <br />' MEASUREMENT <br /> PERMIT - .. ?'r, - fir::.. ~ .~ .... <br /> REQUIREMENT ' I:S"( I"AX . <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 /> 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 ~ ~ ~~ t,n ender prnalh of law chat this d,KVmrnt and all attachment. wrrr <br />d <br />di <br />ti <br />~ TELEPHONE DATE <br /> pn•parrd un <br />rr m~ <br />rec <br />on nr suprnicion in accordance wiUt a p <br />•tem designed _--_ <br /> to assure that qualified percnnnrl properly gntbrr and e•aluatr thr information <br />-'- submitted. Ra• vl on my inquire of the peru~n or pcrw~m who manage the •yMem. I ~' " <br />I _ w th~nr pereons directly mpm.iMr for gathrrir~ ttrc information. the information ~ - - --~~ \ A <br />M1 <br />I, ~ ` ~ J . `. ` ~ % submiRrd is. to the beA ~>< my Anowkdgr and brlieL true. accurvtr. and eomplelr. - L. <br />~ _ ! am uwurr that tbero arc dgnifw•nnt penalties for vhmitting false informnti~,n SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED . <br />ItxludinK the possibdiq of riot and impri•.mment for knowing •iolation.. OFFICER OR AUTHORIZED AGENT COD NUMBER YEAR MO DAY <br />~~......~.. v e~uw ~r•r a.r+~.r..rv~. v~ .-•~e. ..vu.r~v~.•+ t• Bret e.r•.e on ouoa.,rn ~e,aa nc, o~ <br />LIMIT APE <br />T I ONS - <br />PREC IP EV)=NT - SEE' I . A. 2r <br />AY AVG I5 HIGHI~Sl' MQNI~HL1~ <br />t:,. - _ p, - ~ -I~I~. i~ .c ;-ir,irt iitrni. <br />