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PERMITTEE NAME/ADORESS rlarfuAe F'arifiry A'amdlvrafion iJ LhJJrrrrui NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME ~ DISCHARGE MONITORING REPORT (OMR) <br />ADDRESS - <br />Gt- PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY .;tyi~(T Zlal~ ;`+ r, i "- <br />LOCATION ,_,q r l1 YEAR MO DAY YEAR MO DAY <br />FROM TO <br />i._ANC~ i~If1PE. 1"IIr:~ MAAfAE'i.' <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N~, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ • <br /> MEASUREMENT <br /> PERMIT ,} ... __ , .: ~ , ., _ <br /> REQUIREMENT ;.~ • - ""t 'I"I ''~.: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT ~ ~~~ ~- ~ ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . ,. ; ,'a ~ _ - , . <br /> .REQUIREMENT - - -: .. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -. - - , -. - . <br /> REQUIREMENT ~ ~-; vF~ ,i~.•'' : :, ~ ~ i :_. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -. •r : , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a ~ . ,. .. - <br /> REQUIREMENT ` "' =' ' <br /> SAMPLE <br /> MEASUREMENT <br />- <br /> PERMIT • r_ ~.f ~ n - <br /> REOUIREMENT ;C?DA AVv Li ~ T t '~ i-; ;: <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER i ,miry under prnult) of Ian that thi+dorumrnt and oll attrchmenly were <br />d <br />d TELEPHONE DATE <br /> prepared under ms direction nr +upenision in accordance with a ry+trm <br />rsigoe <br /> to aware that yualifitd pervmnel proprrh gather and cvaluatr Ua• information _------~ <br />_ __ - _ _ -~ whmiurd. Raid .at tm inyuin of thr prn,m ur prnom wbo manage the saem. - <br />~ <br />_ -- or those pcruxts din•ctly respon+ible for gatlxring the infwmatiun, the inf ,rmation ~ <br />- <br /> <br />i <br />u, the he+t of m~ km,wirdKe ami helkf <br />+uhmllkd i+ <br />true <br />accurntr <br />and ntmpkle. _ <br />~ 'y /% ~ <br />~~ <br />~ <br />•1 <br />j <br />' - ~' ~ ~ ~- ~ , <br />, <br />, <br />, <br />i <br />Gd SIGNATURE OF PRINCIPAL EXECUTIVE • <br />~ <br />- . - <br /> <br />TYPED OR PRINTE tam aware that thrrc are signdcam penaRies fur whm <br />tti~ <br />+e Informrtiun. <br />incluein the Ihilih of Ilnr and im ricunmrnt for km,wM violati,m+. <br />g ~~ p g OFFICER OR AUTHORIZED AGENT AREDA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference al! attachments here) <br />~}C <br />.~L <br />•=pq [~~ ~- _ - .. - -, _. - -. I I~il~ i~ ,1 i ,,i'i 1tHili. <br />