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PERMITTEE NAME: ADDRES$ rln.iuJr Facdi(r .h'nmmY.rxmirnr i(Ui~errnU
<br />NAME i`wG'r ~ L ~,
<br />ADDRESS - ~ I'I '. ~ __
<br />' ~_ . GRYAi•.'t ST;~ i I[7i~ READ
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<br />LOCATION jN (; O $ I
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (DMR) r•, -• - OMB No. 20x0-000a
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<br />PERMIT NUMBER DISCHARGE NUMBER - - F i ldAl_ LAP1A`.
<br />MONITORING PERIOD - ,j `" ~ "! CANYON
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<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREDUENCY SAMPLE
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<br />t~f:r:•' _ ' REQUIREMENT 30IJA AVG L~AIL.Y MX '"_~~- „ „ , ..
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<br />NAME/TITLE PRINCIPAL E7CECUTIVE OFFICER 1 certit} under penalty of law that this drKwnrnt and all attachments were /J TELEPHONE DATE
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<br />< preparni under my direction or supervision m accordance wtth a system desienrd /~
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<br />N ,~ - ~ J to assure that yualified perumnci prupcri}' gather and es~ahwte the mfnrmanon ~
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<br />- submiti<d. Based on my inquiry ,~f the p.~rwn or pcrsexts u'ho manage the sy3lcm. ~! ~
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<br />f~ ar those persons directly respoacible for gathrring the mGxmation. the information ,
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<br />,ubmiu~d , t thr test of my knowledge amt belief, we, accurate, and complete.
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<br />SIGNATURE OF PRINCIPAL EXEC IVE _ ~
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<br />TYPED OR PRINTED sin :. a, ,c:,c a'r s~gn:ficant perrelties firr submitting tlhe mti,rrnation,
<br />u,clu•6! _ I ~ .~•.tht of tine and im nsomncm far knuuin • ,wlations. OFFICER OR AUTHORIZED AGENT DE NUMBER
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<br />rnnnMFNTC ANI'1 I=YOt Ah1ATllltu (1F AtJV \/Inl
<br />ATIn~IC in.. r.,..,___ _r. _..__~___._ ~___. O O DAY
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<br />4`ER:~GiE IS HIS' - .'G. i~ ..=ERIOD RcFORTED
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<br />EASE - SEE I. 8. 1. D, PG
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