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PERMITTEE NAME/ADDRESS ilnrludr F'ocilitr :l'amdlurarinn tJ (tiJfrrrnfl <br />NAME • . -- L-L~ <br />ADDRESS <br />~_. 1j13X .., <br />. _A 7 8Y~ <br />FACILITY F'i"l'3i~ t_ .'. :.1i'; I ;:. <br />LOCATION ;_A ~_ 7 B ~. <br />ar.lr>= ~,s,a.»t= . ~ r ~`1F twY-T•di4C~EF'i <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 204p-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />DF SAMPLE <br /> EX <br />LYSIS TYPE <br /> ANA <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> -. _ ..-, .. <br /> PERMIT <br />REQUIREMENT ~`' ' f I'3i :;', <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ... .. - _ <br />v G <br />' <br />: <br />• <br />. ~ :REQUIREMENT r;;;: ' is ~ <br />, ; <br />~ <br />_ : <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r. s: r, ... , ~..• .f:.:- r .. ; ,: - : <br />~, r; t: r- _ <br />. <br />. <br />; <br />` <br /> REQUIREMENT _~ !. rte • <br />- <br /> SAMPLE <br /> MEASUREMENT <br /> : ~- <br /> <br />_ PERMIT ...- .... - . ~ - <br />,.,, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> . <br />~ <br />. <br /> PERMIT .. <br />~ _ <br />. _ <br />" ` ~ <br />( . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> .. , <br /> PERMIT ~ . .. , :, ,. _ ,... . <br />_ <br />1^ <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ` ' <br />, <br />~ - <br /> REQUIREMENT - - ~ ~- ~ <br />' <br />~" <br />AME/TITLE PRINCIPAL EXECUTIVE OFFICER I ,rrtiA under pen:dn of Iww that thi.document and oll attnchment+werr TELEPHONE DATE <br />N prr{wred under m7 direrti,m nr wprn-i+iun in uccorduocr with u +~.tan da.~iltnrd <br /> <br />"' <br />" io uanr that yuulified penonnrl pwpcrl ~ gather utd r+almtr the Informuliero - - - <br />( <br />` <br />-"---- <br />"- +uhmiued. Ruled on nq inyuin of the penam or prnon+ whu mane the .farm, __ <br />I <br />~ - <br />_ re+{wmsibke for gathrring the information, Ihr infortm6on <br />xnnn+ dinrtl <br />tho+e <br />' ~~ <br />` <br />` { <br />y <br />ur <br />kt .~' <br />.; - !~' ~ .. '_ r.' <br />r <br />'.fl q <br />, <br />~. - <br />, r. <br />suMnUted i+, w the ba~+t of m+ knuwlydge and belief. tnx. wcurute, and comp SIGNATURE OF PRINCIPAL EXECUTIVE T , <br />, <br />- ~ ~' ~ ~ I am nwure that thrrr am cignirtcunt pena,hh. for +uhmiuing fuhr inforntuhoa RIZ <br />D A <br />T AR <br />A <br /> u <br />l for knowin <br />+xdutkms <br />i <br />e <br />h <br />lh{lih <br />f t <br />d i OFFICER OR AUTHO <br />E <br />GEN p <br />NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />g <br />e pn+ <br />ine an <br />mpr <br />n <br />nm <br />n <br />including t <br />o <br />CpMMCIYI.7 AIYU CAr'LAI`1NIIV1~ Vf MI`al YtV ~r+t~v,•.a {. c. c. c+•a.c v .. .................... .......r <br />FP4 = - <br />This is a 4-dart i~~rm. PAGE OF <br />