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PERMIITEE NAMElADDRESS I(rtrladr facility A'amr/L>rannn iJ 1)ifJrrrrtn <br />NAME <br />ADDRESS _ _ <br />!_.A CL7 EiI~~~ <br />FACILITY y~IZfv !'I.i~E <br />LOCATION ~ ~~ ~.. L+ g I +~ c~4 <br />LANC)= WADE, P'1I1'JE C7AN~~C~R <br />NATIONAL POLLUTANT DISCHARGE ELIMINAT70N SYSTEM ((NPDESJ <br />DISCHARGE MONITORING REPORT (DMRJ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEA 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 SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />-. ~ ~ 1 j J , <br /> MEASUREMENT, ( ~ ! <br /> PERMIT ~;~ -. ~ •lr ,R r u t '~t~ (~ ~ <br /> REQUIREMENT ,. "~A AVC JkILY MX ')`~. ~_ h10~~IT; <br /> SAMPLE -~ <br />~~ <br />i - <br />~! <br />~ ~ a-- <br /> MEASUREMENTI -- <br />:~ ~ -- <br />` <br /> PERMIT +i -t. ~, <br /> REQUIREMENT JODA F+V'C L)A I L ;t .•i X <br /> SAMPLE <br />-- <br /> J r <br />(~J ~ ~? ~ ~~ l <br /> MEASUREMENT . ~ <br /> PERMIT R~r~a-~ .z ,..: _ <br /> REQUIREMENT .~ is ~ '~ iJ1:+F~ r~L':~ i't:=+ i 1. ~ ' <br /> SAMPLE / / r <br /> MEASUREMENT i t <br />r r ' <br /> PERMIT r: ! r-~-It ._- ."~, .. - <br /> REQUIREMENT - _'. ,a:ai:, C1+ <br /> SAMPLE <br />.- . MEASUREMENT ~' ~ ~.~ <br /> PERMIT ,r.;p,7.p..r;. - , <br /> REQUIREMENT _ ~ _ ;~ I i_Y i'" <br /> SAMPLE <br /> MEASUREMENT ~ (~.~ ~ ~, <br /> PERMIT ~ ~ ' <br /> REQUIREMENT L~F~ ~I a , <br /> SAMPLE <br />, <br /> <br />:. <br />MEASUREMENT ,,(( <br />~ `'f <br />( 4 <br /> <br />PERMIT ,• <br />, , I ~ <br />_ <br /> REQUIREMENT _ , 'J~^;-,',~ = ~~ 1 f. i _ ( i ~ . i~~ <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I aarui> under penalty o(law that this d~aumetn and all auachmenrs were <br />de <br />o <br />n• <br />wmd <br />di <br />ectio <br />w <br />• <br />i <br />ion in ac ~ <br />rdu <br />~e with n <br />st <br />d <br />i <br />-- <br />~ <br />d TELEPHONE DATE <br /> p <br />I <br />un <br />r m~ <br />r <br />n <br />r <br />pa <br />n <br />. <br />u <br />m <br />+y <br />rm <br />es <br />gne <br />~ <br />~ <br />\ <br />\ <br /> to Y wee That yualifird pervmnel property Qa111er and e.aluatr the information -~•C-r <br />t \ <br />a <br />-- -~- __ whmitad. ttu+rd on my inyuin ur the prrxm or Ix•rvms who manage the sstrm. - <br />~ <br /> <br /> <br />I I ~ ; - ; <br />~ <br />or th.ne per.uns direah responsiMr for Rathenne the infurnwtion. the infarmatNm - ~ <br />suhmittrrt h <br />w the Ircst ,d m~ knowkdgr• and hrlk•f <br />tray <br />accurate <br />and rumpirtr <br /> <br />~ <br />.. ' 1 <br />~ ~~ <br />~~ <br />- <br />. <br />~ , <br />, <br />, <br />, <br />. <br />SIGNATURE OF CIPAL EXECUTIVE <br />1 am aware that there are significant penaltir. (or submitting fal+r information t - <br />TYPED OR PRIN D . <br />AREA <br />including the possibiliq of Me end imprisonmrm for knowing siolaUotts. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference alt attachments here) <br />.' <br />I <~rnl. <br />