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PERMITTEE NAME~ADDRESS Nnrlni!• P<xilrn r\'umcT.ocufivn iJDiJjennq <br />NAME J• ~: . ~ i M1l':a, i_L_u <br />ADDRESS ' ~ ='' ~ <br />$Fi`%<<ii t ._'~ /`,T I ~:-t~ RiJAD <br />:'3GTIIN ~ ~' 4 <br />FACILITY -_i i<. M _' :~lF <br />~OGA'ION ;~~ ~~~ =Z <br />.-'F eSflrl 11'dr7r^J fILSRif=R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE$) <br />DISCHARGE MONITORING REPORT (DMR) <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 />- 1'S- <br />NOTE' Read Instructions before comoletlnq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREGUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r -s ' ;` - ' <br />_ _ MEASUREMENT <br /> PERMIT ~ o-~:r ~ ... # # ~;'st#### RE L !~r',„ <br /> REQUIREMENT 30PA f1'•! t1X 7D A`J "'•.- M~)rITH <br /> SAMPLE ~ : ~ :r ~ -a .. .. .:_= , <br /> MEASUREMENT <br /> PERMIT ' ' • <br />- _ '! REQUIREMENT _ ;;*-x~ h? IN l: 111s"! ~ MAX I MUI"I ' <br /> SAMPLE - . - <br />' <br />. - -- . _ MEASUREMENT ~/ <br />_ PERMIT ?~~#=sF'.f# ;r #-~ •a# r? t ~. r+.f',:, <br />_~ <br />_ - _~- _; ~- <br />REQUIREMENT <br />30D'` <br />f'(X 7J A`' - <br />i•it. "i- <br />MO~lTf' - <br />• <br />_ ~ SAMPLE ~ ,. :.: t i ~ <br /> MEASUREMENT <br />. PERMIT ###-sF-'rf# ., ka Kt 'x~ ;r#iE~F## -iF#'.f##?>• _ <br />L - _ ~ `r ^- REQUIREMENT x~ LNST MAX L ~1_I~I r <br />I SAMPLE { :?.., J: ,, _ # ~ -:.~• <br />' •:~t.! hit.AThlcF.i7 ~Lr MEASUREMENT <br />` ~ PERMIT EPO T ~P T #dt##it•# ~•####•~ ## ~~a :; ;,•• _ v. . . <br />' REQUIREMENT ':iDA AVG .': ~ILY MX ;~_: <br /> SAMPLE ~'r~'r;s~t :'r~~ # ~ it#~x-, r ; <br />I _- MEASUREMENT - _ <br /> PERMIT k: :~ ;~ #-~'x~#9t 'r ,. #?F. J#-a~ ,. ~. .. ;i <br /> REQUIREMENT - -- <br />/ :-:^DA~GF."? MX7DGEOA <br />' ' :''" MOi l`i-i <br /> SAMPLE - ,.. o s ;r a S ~ a -: '.h or yt si z <br /> MEASUREMENT <br /> PERMIT "~ -- .-' -.~#~•#=5 `i-! ::.- -sr ~--_ r•,.. __'-:r1t_ <br /> <br /> REQUIREMENT L j'r3'T ;_ P'IFi Y; <br />NAME/T1TLE PRINCIPAL E7(ECUTIVE4FFICER I ;citify undo; ;+cnatr..rt Iaw that this da-umcm and all anachnxnc:were ~ ~ TELEPHONE DATE <br /> <br />~ -i <br />• prepared under urn durarun or suprrvieton m aca>rdancc wuh a system dastgncd i <br />`~ ~.~ ~ r ._ • <br />~.4 L~ r~ scstuc that y,talified pcrsanttcl pmpcrk gather and rvahwte the in(ormauon <br />~ <br /> submittrd. Based nn my wyuin~ o(tbe person or persons whit manage ter system. - i <br />% ~ _ - <br />r f g ttte in(omtutwn <br />the mlort»atign r <br />or those perk+n> drr-ctly r•spc+mtblc lot pnthcri 't' / / ` <br />{ ~- <br />t <br />~ <br />' g <br />. <br />t <br />o <br />led <br />nd heG~fi <br />ttv <br />a«tuat2 <br />and com <br />let <br />b <br />itt <br />d e <br />the b <br />t <br />f m <br />k ~!l r L / <br />G Q <br />l. <br />I <br />~ <br />~ ~ ( es <br />o <br />w <br />ge a <br />c, <br />~ <br />p <br />e <br />su <br />m <br />e <br />s, <br />o <br />y <br />n <br />. <br />i <br />i <br />N <br />i <br />G <br />f <br />l <br />l SIGNATURE OF PRINCIPAL EXEC IVE / <br /> <br />TYPED OR PRINTED ur subnutung <br />u <br />se <br />nlonnat <br />on. <br />1 am aware tlmt t <br />cre err signif <br />cant pcna <br />ics <br />including the possihtlity of line and imprtsonnxnl for knowing eiolnGons. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />IS ANU EXF'LJ4NA1 WN yr Alva vIVLAItVrvJ (He-erence an aaacnmenrs Here/ <br />-'iOD REPORTED <br />- .. -- , . <br />~~LS IF',a-4=pelt ~C)ml. PAGE OF <br />