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PERMITTEE NAMElADDRESS!lnclydr Fact7ify.Yttrnellnratinn iJ(h;Q'rrentl <br />NAME ~~ r7~U t ~ Li, <br />ADDRESS ~'1 : ~vi_ <br />JX •~,=8 <br />co ~l~a~ <br />FACILITY ., ;-i;_;; ± i ,'. '. ii'~t I'1 I f iE <br />LOCATION i,-~ ~ ('i J $~ L{~c~ <br />.-.... ...ter r•rr~r w~!'.1f 41't t~e'1 <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 Approvt3d. <br />OMB No. 2040.0004 <br />r t+~ns-. <br />?:F1I14F 1)r~1V6 TR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING DUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />of <br />NALYSIS SAMPLE <br /> <br />TYPE <br /> A <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />~ SAMPLE I - <br /> MEASUREMENT~ <br /> <br /> PERMIT ' <br />REQUIREMENT <br />SAMPLE - ` ' <br />- , . <br />Dr; - <br />;-: <br />~it1Pd? <br /> MEASUREMENT <br /> ' ~,, <br />; . <br /> PERMIT <br />REQUIREMENT; <br />SAMPLE ~ <br />' ~':~ ~` t; >rP l <br />3R T <br />7QUA At+C; R Ef= qft " <br />1~A; i_ ~ <br />I,. <br />~ MEASUREMENT <br />, <br />r :C ~ <br />1"t <br />. i. PERMIT ...~r:± <br />REQUIREMENT t ::~~PT <br />.,, Avl: - I <br />.•1 ~ . <br />_IVC <br />r'~f-'"•i_i :~ <br /> SAMPLE <br />•_;; <br />,L MEASUREMENT <br />_ PERMIT ~ <br />REQUIREMENT ~ r :~ •it ~L` <br />i 1D. r Ft 1:•,_;: <br />DFt I 1 '+ <br />, <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT ~ <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER i rrrtir, under pen:dt> or low Ihat mi+a:.ratm•m aftd au vttvrhmrn~+were <br />prepnrsd under nn direaYiun or wprnnioo in acrurdance with a system de4lgmd TELEPHONE DATE <br /> <br />.- " " ~ _ <br />- to r4+ure that qualified prrwnncl prv~•rt~ gntlrcr and rfaluule the infurmytinn <br />+ubmittfd. ftasrd on my inyuin of the pcrv~n ur persnn+ whu manage the +ystem. <br />er+iats dinrtly n~punsible for gathering the information. the in4xvmtloo <br />or th~nr ' <br />I - <br /> <br />- <br /> <br />~~ <br /> <br />- w <br />} ~ <br />I (~ p <br />+ubmittnl is, to the tfr+t of my knuwledgr and belief. true. ac~rurate, and a~mplete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~ <br />~ `_ ~ ~ ~- ~ ~- <br /> I am aware that there are +ignifiram penultirs for submitting fal+e information. AREA <br />TYPED OR PRINTED including the ptK+ihilih ..t fine and imptisonmcnt fur km~wing+inlatiun+. OFFICER OR AUTHORIZED AGENT DE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> <br />I IIIS 1~ J <br />