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PERMITTEE NAMEiADDRESS ~lncBaleFix•iliq A4urm'L.xarlonifprffc,rnlr <br />NAME .~t .. ~'.~, _i. <br />ADDRESS ~ • • (i~ <br />GP'~'r'~iV 5TAT It.' ~ ~= 7r=iL' <br />;'V:,TON K. Y' 405 i <br />FACILITY °LE~ i7 i Illy <br />LOCATION ~ ^.~ C; O 8 1 Q5 <br />f ~~~rr INGTON. '3WNER <br />NATIONAL POLLUTANT DISCltAAGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) - <br />_~ i. r 1; .. .... 1 <br />PERMIT NUMBER DISCHARGE NUMBER - F I fVAL. ~-AI" <br />MONITORING PERIOD -•~ ~`~ D I R T R I t:%~"F2 <br />YEAR MO OAY YEAR MO DAY <br />FROM TO ,,~ I <br />NOTE: Read Instructions before completing tfiis form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE s t: ii ... <br /> MEASUREMENT <br /> PERMIT - • .~~ r°:-{"-# it :'.i•i~ ,: :- .L:. -. i <br />c ~ 'v •= REQUIREMENT ~ `''A 7, I I"!UI/: . - <br /> SAMPLE '` ~ <br />~ - ~ MEASUREMENT <br /> PERMIT t.# ice. ...-#•~ t> '.#i= •ti•:ci:ir~-# : t: {:. i.% •:r`-t <br />--; - _c ,-~- _. REQUIREMENT - .. ~`+'- ,:~ A`v 1.10(VTFi <br /> SAMPLE t.: .--r#rt <br /> i <br />! - <br /> ME:ASUREMENT ~~ <br /> PERMIT ;: '"ct:•iFt-# #! :.~?#ir r t -' <br />~ ,t. ~•r '+t L-/ <br />.. • , REQUIREMENT ~ Li~i I L Y• . , , <br /> SAMPLE :~ s- s t: - { ~ a - .. . <br /> MEASUREMENT ~~ (~~ <br /> PERMIT i, # y- _ s- 1sr~ # # ): ,:.... ... ~,. C <br />- ~ '.%A~..!J: REQUIREMENT , . - "3C'u~1 Ali r Taa i L r l o`. ,,, ~ i`;izW•i N <br /> SAMPLE .. .. - <br /> MEASUREMENT <br /> PERMIT x ###tF# ,. :: i~ tt • a: x ~-it••1`- ~'.f• i•~ ~ ~ <br />- T L ~ ': "•~ " 'J:'• : ! ' REQUIREMENT 1 S~JST i"1A'' G i• f4T <br />~ SAMPLE ,- . - -# :r - .. <br />T~NRU 'R.`..'r? i I`:EPv l PL~ .' MEASUREMENT <br />~` : :1 PERMIT - #.^': ',r #~ trt# " # _ ~ .. r . ,. <br />_ r ~ , -~ REQUIREMENT >t1A A'JG ~y. ~-- <br /> SAMPLE ...<t>riE~r ..-~ max-: --~•r::; . <br />.-. MEASUREMENT <br /> <br />PERMIT <br />„ .- <br />~ _ ... <br />- ~; <br />.. ~ ., - <br />~ ` - ~ REQUIREMENT ). 1~ 7 t PiAX <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ecrtifi under penalty of law that this document and all nt[achmenu were n r <br />' I TELEPHONE DATE <br />_ <br />~ prcparc•,i under my dirccnon or supenistun m actiurdance with a system designed - <br />~ <br />~ <br />( <br />v//~~ ~ I ~ ~. =/ r' ~~CS dl l ~t to a_csun: t}wr yuahfied prrwnne! properly gather and e.~aluatc the r ~~rtrwtinn <br />b <br />d <br />B <br />d <br />C <br />h <br />l <br />h / <br />/ <br /> <br /> <br />i '~- <br />mutc <br />ase <br />on my mywry o <br />e pcrsen or persons w <br />e svsiem. <br />su <br />. <br />t <br />x, mans a t <br />„r those perseerts dimtly rt-s7wruibk far gathering the mfomtation, the mti,rmatinn ~~ <br />j <br /> <br />- <br />~ j ~- 1 I u`+minrd r to thr best of my km,wlnlge and hclrrf, true, accurate and armpl~tic. <br />lnec her <br />rb <br />I <br />~ chat th <br />re ar <br />nificant <br />e <br />rtt <br />t <br />l: <br />u~ SIGNATURE OF PRINCIPAL CUTIVE f' '~~>' , 1 ,, <br /> <br />TYPED OR PRINTED m ~. <br />e <br />sig <br />p <br />na <br />. <br />m <br />mg <br />c m nn. <br />orr• <br />o <br />n cJn ih: p„ssiMhty a(ftnr and impnsonnicui i"• know in •. ~ iy ic, OFFICER OR AUTHORIZED AGENT AR A <br />NUMBER <br />YEAR <br />Q <br />D <br /> CODE <br />I.VMMCIV I.1 qNU t7kYWIVg1IVrv Vt gIV7 vtvual wrva Irreverence an anacnmenrs nere~ <br />IoD REFnRTED <br />i 11: - ~. t r~lV? A <br /> <br />DIL Rs GREASE - SL-E I. D. 1. D, P. S. l <br />,PPLIED FOR ~=14YR,~4HR PRECIP EVENT- <br />t TMT TC int toncnt nc oo nt-SC 6CnM.hITC_ A 7 <br />1`.Iti ..i• ,fi :t.i~i <br />