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PERMITTEE NAME'ADDRESS rlnrlurleFix-ihn A'umciL<xarrnnifDr~•rcnu <br />NAME _ - <br />ADDRESS ` <br />AT ZI'I'J Fit~JA[1 <br />K'f ~~f <br />FACILITY r ~ .yt <br />LOCATION `~,~ CD eI <br />- : ~ i~u~'' II•~iGT"4'Nr 01.1raER <br />NATIONAL POLLUTANT DISCHAAGE ELIMINATION SYSTEM (NPDES) Form Approved- <br />DISCHARGE MONITORING REPORT (DMR) OMB Na. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER ~- - F ; hdA' . LAMA <br />MONITORING PERIOD ~ `~ OQ9A <br />YEAR MO DAY YEAR MO DAY <br />FROM - TO - ~ ~ ~ - <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE r: c- ':- , , <br /> MEASUREMENT <br /> PERMIT `:~-~'~ r' 'sue tr#••;r## 1=R- r. _- <br />. , REQUIREMENT ~=~`+: Mil VAL.'JF - Ff, <br /> SAMPLE ;:- ~ t- - .. i ~ ~ <br /> MEASUREMENT <br />. PERMIT it+t#tE#it• #+: tt+>iE# t- ~~ir ### ~ "r.R- :_ r .. <br />~ = REQUIREMENT ' x ~- <br />{`IN - <br />i- <br /> SAMPLE <br />MEASUREMENT / <br />-"1 l I <br /> mo/ <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE • <br /> ~ <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 EiXECI.ETNE OFFICER I certify under penalty ..1 law that this document and all attachments were J TELEPHONE DATE <br /> <br />! prepared urrdcr my drmcuon or strpen~ision in accordance with a system desicned / <br />' ~ C <br />,ir,~t' ~J i % ~ t~L C ' ' to as,ure that qualifieci persrmncl pnrpcrly gather and evoluate the mfornwtion <br />(, n ~ submitted. l3asad un my inquiry of the person or persrnu who manage the system. '~ ,~ ~ ~y.,r/~ ,~ <br /> <br />~ <br />~ <br />< <br />~~ ~ <br />~ or those persons directly responciblc for gaihenng the informafion, the information <br />l <br />~( <br /><< <br />' <br />( submitted is, to the best of my kmialedgc and belief. rrur, axurata_ and complete. <br />- <br />I SIGNATURE OF PRINCIPAL EXECUTIVE ` ~ <TL - t / <br /> am au <br />arc that thcrc arc signific.mt pcnahies for snbmrmng false mfirrrnanun, <br /> <br />TYPED OR PRINTED <br />nauding the Ixrcaihiht} of fine and imrn+onnunt tier ktxnving crolatioac' OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />M <br />Y <br />r(1MMFNTS ANf1 FYPI AAlnTIntJ nG nnty vtnl nTrnt.te io..s .............rr ..u__r_~__._ ~___r CODE <br />= .- I A ~: ~F' ,I-~ FOR ?'rL'~TA7LS DF TEST FR[ REPORT LCD <br />- - _ r TES' ~ _ ~^a. ANL7 Al-T , :- TOX X t~ I TY T <br />- ., ...r -r, _ <br />- . , ., ' : ~'hf$ QS' 8 d~~Cy f~OiTri. PAGE , OF <br />