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PERMITTEE NAME;'ADDRESS ~/n. ;u~ie F'aciJin :VRme'Lncvulat {IDijje <br />NAME - <br />L. <br />ADDRESS <br />FACILITY - _ t°. • . -_ ' <br />LOCATION ~~ ~- <br />~~F r~IidlNt~T%sIV: l3WP•iFR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FOfm Approved. <br />OMB No. 2(340.OpD4 <br />DISCHARGE MONITORING REPORT (DMR) <br />' ~+lf:. i. ~. . <br />PERMIT NUMBER DISCHARGE NUMBER - F I NA~_ i_. AM <br />1 ~ MONITORING PERIOD ~ - ~ ~ ~~- FOft OCI :== <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ TO - -_ <br />NOTE: Read Instructions before comoletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREDUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE _ s ,a . .; t't'+ <br />'~ -. MEASUREMENT <br /> PERMIT 's a ->## t , ; ~ =r # st 'C7 C' ! it r- :w ~ - -_ C <br />_. F ;-` ,_ . -.. REQUIREMENT ~ar•x a P1N VAL _;~T <br /> SAMPLE -> a <br />L ._ t <br />`' ? P ~:. ` . MEASUREMENT <br /> PERMIT ',r##~.t-•#5t it-:=i -rst# •~7 F#-~• 1 ##x#:e-if• si#7e ~ r t. - L' <br />-r ~ LI~%I'!~ •'_i`: - '.!i REQUIREMENT - ~ -, f-1N VALUE - i,t' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br />MEASUREMENT I ' <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 I certifi' under pcnaln of law that this document and all attachments were ,1 ~ TELEPHONE DATE <br />,~ - , i <br />~~ ,~ / %•~ ;; ~ ~' r i, i. r ~ ,~ - prepared under my direction car aupervtsiun m ucordance wnh a sy~st~tin desigrrcd <br />to aacurc thnt yunhfied pcrwnncl properly gather and evnluatc the in(omunon ~/? ~,~ J <br /> <br />' <br />,~ f <br />~ submtttc~]- Baud tin tm myuirv o(the perwm or pcrvetu who manage the system. ~- <br />1 r~r those penuns duectl~ re pvnsible (or gathcnng the infixnwnnn, the m(onnatitm <br />} <br />r ~^+° S ~ rr~ C J ,ubmttw~d is. in the besr of nn' knew led ~e and hcLc( true, aa:uratc, :utd ce lete <br />~' ~' <br />I <br />m <br />a <br />t th <br />ili <br />t <br />th <br />• <br />l <br />i <br />F <br />i <br />i <br />( <br />D <br />i <br />f <br />b <br />i <br />SIGNATURE OF P INCIPAL ECUTIVE - t ~~ `[1 <br />- • I ~ - ! j~ ~ <br />L ~ <br /> <br />TYPED OR PRINTED , <br />,r <br />ere arc ,icn <br />are <br />a <br />~_an <br />p~ <br />na <br />t <br />c; <br />+r ;u <br />rn <br />n <br />ttg <br />.+ <br />+e <br />ormnt <br />n <br />ua. <br />~iu~hc~ the paxclbdity .d ilrir dnd nnp:;5. nmrr~t inr knuwm. cn~latione OFFICER OR AUTHORIZED AGENT AR A <br />NUM R <br />YEAR <br />O <br />DAY <br /> . CODE <br />I.VMMCIV IJ HIVV CAYLHIVHI IVt`1 Vr HfYT vtvtsat wrva frrererence an anacnmenrs Here/ <br />_ REPOR i LC~O - ~;TATI` <br />..iF TOX'.~ r <br /> <br />T ESTIMATE WHICH IS <br />1 lu; jc ~t -~-it;;rt i~ ; <br />. OF <br />