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PERMITTEE NAME/ADDRESS (lndude Facility Nanldl~carinn if UiQerrnll <br />NAME , .. . , t7'~; , ~_ ._ ('• <br />ADDRESS •'• <br />~~X e7c:Z <br />FACILITY HOR I ~ ~~j I`1 + i• } E <br />LOCATION Lt4 i ,, 0 D 1 Q t ~} <br />s ww1rC' J.1r '- MT11L 0.11\plAf'1=4 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <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 />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ <br /> MEASUREMENTi <br /> PERMIT - s ~ ~ ....-. ~ ; . _~ -.- <br /> REQUIREMENT ";VG DAI! 'Y M7 h:~ll~IT+- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. -r ii•# i4 - ::~ k =; ~~ r.:.:.. ~ i 1 \ 1 <br /> REQUIREMENT ;7L'~- - D=, :. [ . r" ;-? <br /> SAMPLE - <br /> MEASUREMENT <br />J PERMIT ~ a• ^-:c ~ rz r-LJ - ;~ ; ~. " . <br />- ~.+• <br /> REQUIREMENT :il~GF1 i-i4r1~ FIhIL.Y ~•+, ;~'- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT N .r-~ - iF~~#-'x3t :f ~t't-f ...... ~ .:,- r <br />' , . e~ <br /> REQUIREMENT ~;DA f>V~_~ ~i~ii_•`!• :~ ':- <br />`iCl. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ I r <br />- <br />' <br /> REQUIREMENT :-iODA ,'' ~ DAILY" i•'i~ i', ''~ <br />1 <br />r- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,.. ..~#' .-. ~ i, _. _ <br />' <br />- _ <br /> REQUIREMENT ~:•l.i:'• '•.~~ .r <br />~;r=~ ~--t' r, ,. <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT . -. •{ < - - _ . -.. . t . _ _.. <br />REQUIREMENT •:, >-. r_. ; ~",. ~'~i~ :,~: ~ . <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I \rnir~ Ynder p•nY{I> or IYw mm mi. durYment Ynd Yu atlYChmenb were _ TELEPHONE <br />- DATE <br />prrpYrrd tinder m, dirt-+9iun ur wprniniun in Y Yurdem~e wish u .~+lcm da- igned _ <br />' <br />In a~wrC IhYI 4t1Y1{t{ed ptrsoMd properl\ pplhcr Ynd r\alunlr the IntYfrllalhM <br />. ~ <br />~ / `•. <br />- - - -`- ~ __~ whmiu+d. Na,cd ,xf m~ inyuin nt the Ik•nun ur penon, who manYAe the +r,lrnt. -~, ~ <br />ur Ihow~ penons dinwlh n+,puf,ible for RttthrrinK the infnrftwliun. the inrormmtion ~~--~~ ~ + <br />l <br />' <br />~ <br />~ / / ~ <br />~ <br />~~ ~ ~ ~~'{ <br />- - "~ <br />~ <br />,• <br />.- +uhnfill d i.. to thr best u! m~ knuwledile Ymf 1KIicL Irue, uccurYle. Ynd cump <br />, <br />_ <br />elc. SIGNATURE OF PRINCIPAL EXECUTIVE <br />~ <br />- - <br />_ I am aware Ihat thrrr nn• .igtlificYnl penalties for whmillinR tak+r information. AREA <br />~ d i <br />l f <br />r k <br />wi <br />\i,dYli. <br />s <br />l <br />f ti <br />i OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED mpr <br />wnmeY <br />no <br />nK <br />at <br />. <br />iq o <br />nt en <br />o <br />indudink the pcn,ihi DE <br />COMMtN 1 5 AND tJCF'L.ArvA 1IlJn yr HrvT <br />FP,~ Form :...0"; ~•3a,.; c 5l} p„w~;iu5 e.~,Y~.~r:_ .. - -. <br />~ - -- <br />Inrtert;nt:r yin nuawnnrtua nc. c~ <br />rfl't5 Is :t $-Dail fOT11l• PAGE OF <br />