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<br />, <br />, ~ ~~ •~ v... NATI <br />~ <br />:. ONAL PGLLU TANT DISChARG"t hLI LIINA710N 51'ST"cM (NPDES) ~,.', tlu.-!> > ''1 "'" <br />_ „ _ <br />, <br />PERMITTEE NAMErADDRESS ~„ .. r:,,, .,. •.,, ~ , , .~.. . ,, <br />, <br />.•. ~ DISCHARGE MONITORING REPORT (DMR) <br />NAME <br /> pp / <br />~1~~1 ~" ~ 200 <br />ADDRESS PERMIT NUMBER DISCHARGE NUMBER <br /> f ReclamatlQnr • <br /> plvision ~ <br /> Miniltfl and Safety MONITORING PERIOD <br />FACILITY YEAR MO DAY YEAR MO DAY <br />LOCATION FROM <br />d Instructions before completing this form. <br />R <br />NOTE <br /> : <br />ea <br /> <br />---- <br />n^ NO. I FREQUENCY SAMPLE <br />~I^C~ITI']ATlflhl i <br />PARAMETER QUANTITY OR LOADING `""^"' • "•• --"'-'--- EX -'• 1 Trc <br />ANALYSIS <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br /> MEASUREMENT r ' ~_ ~:;~.:. '': ;'i` ~ <br /> PERMIT r.- <br />, <br />• <br /> <t~n t'i I N 1 MVM . , y, <br />, <br />~f <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT T f ~ t.l „_ f .._ <br /> ,r <br /> PERMIT .. <br />3JDfa ~1V'_I .. T ; <br />~ • `~ i' ~• t: r~tr:JPl 7 t <br /> REQUIREMENT <br /> • <br /> SAMPLE } <br /> MEASUREMENT <br />~ <br />R ~ n rl t' T <br />5 <br />) ~ ,~ <br />- ., <br /> PERMIT ;> Jy.': ~ ~: t- •>; ~t A ~ i :: ;* -: 4 <br />u . <br />. '4VC . <br />I)A . "iON i i-'. <br />• REQUIREMENT t ~? ; <br /> <br /> SAMPLE <br /> MEASUREMENT ,.~ r. i, .r•; ~~ : ~ ' < <br /> PERMIT - - .. <br />-• •~~~- :'J;~ <br />• <br /> REQUIREMENT <br /> <br /> SAMPLE t< <br /> MEASUREMENT u ~ <br />~ •_ / Ct i• (~( - / •-+.J <br /> PERMIT _. - .t _ h1UN 1 <br /> .'r_Il~fi `+: ;: <br /> REQUIREMENT - <br /> <br /> SAMPLE ,t -•' t r <br /> MEASUREMENT (~' _ ' ' i : _ <br /> - Y-• st,; ' <br />PERMIT ..~r'. G <br />REQUIREMENT <br /> <br />SAMPLE <br />MEASUREMENT : -., I; ..:=1~ _ :~ ",~~ ' ~+ . <br />PERMIT r t ~`Jr, T - <br />' <br />REQUIREMENT a ~`."~~. '- (_Y :" <br />TELEPHONE DATE <br />NAME:'TITLE PRINCIPAL EXECUTIVE OFFICER I srtdy nlt.tc• I,.. ilq .a law 11u1 Ini'• 41a UIRCrII anr{ UII nlla~Ii RlCnt> NCR' /P. <br />m to a~cnrdancz ls~uh n ~~~±tlnl (1~'"t'rIC11 ~* ; <br />..• <br />r~ 1+t <br />i <br />~ <br />~ <br />~ <br />rer n.m nr .upz <br />d <br />prellnrcd une:~ ~ ~: <br />~ <br />to a~surc that yn.:~.firci pcr~onncl pt.,pcrly gather sru er~aluutc the tnt:mtlahon ~-i ' ~ <br />:uhmm t 8;,. J - n mti a rluir t th persr n r hers n u h -~ •ruutucc the ;y stem, X ~ <br />.r th c per .-n. I reeth r .'p rlbl t-a gnthcnng tt ud mt,uulr.. the imarmnhou - -_ <br />L:urute anJ zuntplem SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br />i h <br />t tru <br />d <br />h <br />~ <br /> <br />' <br />e . <br />t.r m, <br />_ <br />a <br />• - ~ .~ r, n ~ -. •- ' ~ r' ~. !!T uhminc 1 r t th best m kn alc <br /><nalu: .::t a,LaunmE Llhz ndorntn°an. <br />:1•nc;ult <br />r <br />h OFFICER OR AUTHORIZED AGENT I -~- <br />AQpE NUMBER YEAR MO DAY <br />1 <br />e nrr .•. <br />~ ~ . <br />I am .nr~rc t <br />- . _... ~...,... ,..t ,.,.,~. C <br />I TYPED OR PRIM I to I ,::~:~::,: _ , - ~ ..... . . ....... _ - <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 332U-i (Rev. 3, ~) Previous edillons may be usE'd I -- <br />