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PERMITTEE NAMElADDRESS Nnrludr hacililp A'amr/(.uca/ion iJllifJrrvnrt <br />NAME - <br />ADDRESS - •- <br />• jitl ~ ~ tee'. {J <br />{~~ ~l~it~'i• <br />FACILITY °~~ i ~i_r~v iii j;ai= <br />LOCATION ~ i, j Fi 1 .:, ;_ •'I <br />~.tUt:e- WAflF=. i•17Cv- rtAEVsaC;`i/R <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. 204D-0004 <br />-~- <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br /> <br />OF <br />SAMPLE <br /> EX Y <br />IS TYPE <br /> ANAL <br />S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />• SAMPLE <br /> MEASUREMENT <br /> PERMIT ss•~#dr•~;-: ,.~a-4:< .•.i,,'.;t :>t, ._ ,-. <br /> REQUIREMENT <br />t3R T iY : c; ;~- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. r •, . l <br /> REQUIREMENT ip;i t-R `~, •" <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERM{T lr at•'k •iS•-?t •ft - ~ , ~ ,a :t , .a• ~ , s :. , <br /> REQUIREMENT ;. a' ~`~~.'~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I crnir> under prnahy nnaa mm chic dorumem and au attarhmrntr sere _ - TELEPHONE DATE <br /> prepared under m7 direction nr wprn hion in accordance with a s~+trm dtrignrd ____ _ ~ <br /> to arrurr That yuulifird prrumne! prnperh gather and e+uluatc tlrc informati~m <br />~~ <br />~ <br />- -'-- -' _ vuhmhtcd. Ru+cd on m+ Inquiry of the per.crn or prram+ who manrge the rv}tem. ~ r~ ' <br />_ or chore prnnrts direrth re,gm+iMe for gathrring thr information, the infontmlioa ~ / ( <br />. ~ r <br />~ te <br />om <br />Me <br />f <br />d I <br />t <br />a <br />c <br />d <br />h <br />h <br />f <br />k <br />• <br />d <br />li <br />l ~ c1 ~ / ~ 4 r <br />r h f ; ; ~ <br />- ;. ~ ) ~ <br />' . <br />rrt o <br />, <br />rue, <br />c <br />ura <br />. an <br />e <br />p <br />whmitted h, to t <br />e <br />m+ <br />rwr <br />. <br />r <br />gr an <br />x <br />e SIGNATURE OF PRINCIPAL EXECUTIVE <br />~' 1 am aaare tlmt Ihcre are siyniticant penultin for submitting false information. AREA <br />D risonment for knoxing violations <br />th <br />sihJit+ of riot and im <br />i <br />l <br />din OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTE . <br />g <br />p <br />nc <br />u <br />e M <br />COMMt(v I S ANU txYLArvA l wrv yr Hrv T V WLA f IVI+IJ (nert;rerrce en auncrnnrnta rvcrr/ <br />i~S LIFIIT <br />=~ UG t I DN5 <br />.. .. :-u~nrnlr~~ ai:i;tiC!fi rill=i-iirFFii <br />` -i:',_ h,-. P'.. - ... III .. :.1 -!1..~( ti~q-. <br />