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PERMITTEE NAMErADDRESS aim r:,.i: /.;. do; ~~r,r+, ! ~. urnw v : trtt,:. ~;; <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <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 />CIMB No 2040-0004 <br />NOTE: Read Instructions before Completing Ints rorm <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION NO. rHtuutnt.t SAMPLE <br />DF <br /> EX LYSIS TYPE <br /> ~ ANA <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - - : , I •, , <br />/ <br /> MEASUREMENT I Li J - ~ ` - <br /> PERMIT .... ~ A-= : a -: ~r : G C7 i.~ _. . .. . , - - J' + <br /> REQUIREMENT (-~iy ::.! ..i[. f~,~.:;.. <br /> SAMPLE ` ~ ~~ i (,~ _ <br />{ <br /> MEASUREMENT (~(% ' <br />• ' t <br /> PERMIT ~ . ,... - - ... 1Crl OOfii .. .. ~..#-~s: F: .t=^iT- - <br />F REQUIREMENT '•?^! 'Jii~UF, APJr~•:F= <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />?iTLE PRINCIPAL EXECUTIVE OFFICER <br />NAME t .cnih under ixmalt> of laa that @tn d.w'umrnt ;md all uunchmcros were TELEPHONE DATE <br />, r rm Jnecuon or >u{~<ntann m accordance •a-nh a system drs;encd <br />3 und <br />ar - - <br /> a <br />e <br />prep <br />n+assure that y+mli fiul {+rr,unnel pn.perh gather and evn!uate the mfunnattun -~-- <br />- - - - --- - suhtnnt~ ii. Raxd on my mgwry of the pcru.n nr pl runs w$u mm~ugr the svstcm, <br />the infomtauon <br />~+n.ibic for eathering the mtirnnatiun <br />` dn <br />ai <br />n~ <br />h ~ __ - - <br />~ --- - -- <br /> , <br />~.tr i <br />a.c pcnur> <br />{ <br />c <br />y <br />suhtmucd n. to the h.~t ,•f ms kmuwlcdgc and ttehef, true, acciuatc. and rnnplMe <br />SIGNATURE OF PRINCIPAL EXECUTIVE ._ <br />- ~ % a <br />_- <br /> I .un ar~arc that ihrrr .d..i~ndicant permlnex for submitting tai>e mf~~nnar~~0' CER OR AUTHORIZED AGENT AR A <br /> nmtin <br />tiol <br />tnm. <br />m fi <br />t <br />i <br />1 OFFI CODE NUMBER YEAR MO DAY <br />TYPED OR PRINTED ttnpnsnnne <br />>r <br />. <br />g <br />a <br />mcfudm me {xnah:ir•. ,~t t <br />ne an! <br />COMMENTS AND EXPLANATION OF ANY vIULAi wrvs (rrererence an arracnmenrs nerr~ <br /> <br />