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PERMITTEE NAME/ADDRESS ,locltrc/r Frrillry •Nomc2~r:ariorr iJD;(Ic,rrul <br />NAME <br />ADDRESS .. •- - <br />FACILITY <br />:- Fi <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 Approveu. <br />OMB No. 2040-0004 <br />OW) <br />I r~>w~ RaL.AAa <br />S!^G`I t'c7NiZ3 TO RED WA5~i • <br />NOTE: Read Instructions before completing this form. <br /> QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br />PARAMETER ~ ALY <br />S TYPE <br /> AN <br />SI <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ '' <br /> MEASUREMENT <br /> PERMIT `~ a <br />..t <br />.,. <br />- ~ _ REQUIREMENT <br />"_ :. SAMPLE <br />•;IJ~~ } - ~ MEASUREMENT <br /> ~ ~ r. ~" _ <br />- PERMIT <br />-F 'r REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br />. r. ,. -; : .: .. i _, <br />. f PERMIT I`IUi•; ? ~ i <br />;f" REQUIREMENT <br /> SAMPLE ~ • <br /> MEASUREMENT <br />~ - PERMIT i5 i:• - : .. r .~ ~ t', • , - <br />- <br />r -, ~ -a <br />REQUIREMENT <br />' t <br /> < :i ,~ <br /> SAMPLE <br /> MEASUREMENT <br /> . ~ r ~~-st•r ." . -.. -, , <br />T . <br /> PERMIT ~ , <br />_.- , -. REQUIREMENT . , '`~ t ~ - . ~ G>=a~tT <br /> i`;, .. r. <br />', SAMPLE <br />• ;~ .•! - MEASUREMENT <br /> PERMIT • <br />- . , <br />- i REQUIREMENT , ;r,l <br />r '_; <br /> SAMPLE <br />• <br />~~. <br />~ MEASUREMENT <br />_ <br />, <br />- PERMIT <br />_ ~. . < REQUIREMENT C;•1•l i'f~'. _ t ` <br />E PRINCIPAL EXECUTIVE OFFICER <br />AME <br />ITITL ~ .enify wxler penatry of law thin this drkumcnt and all attachments wue TELEPHONE DATE <br />. <br />N <br />. prepared under my direcuon or .upen'isinn m acrnrdancc with a system dcsignal <br /> <br />~ ~ to assure [hat ywdifitd personnel properly gather and evaluate the mfnrtnalion <br />ersons who rmtttn <br />e the system <br />erson or <br />l'th _ ~-- - _ <br />~ "- <br />si~ ' <br />' <br />J e 6• <br />` g <br />, <br />e p <br />p <br />submitted- Based on my mywry o <br />the information <br />onsible tur gathering the mformation <br />res <br />di <br />d ~ <br />_ <br />• <br />~"~?~ ~~ - ~ '~ <br />~ . <br />p <br />rr those persona <br />ra <br />y - C ~ <br />~ <br />,; t .~ihmuad i+. ro the beu of my knm+kdgc mtd t+clicf, rate, accursre, and complete SIGNATURE OF PRINCIPAL EXECUTIVE " <br />' < " <br />- i em aware that then arr stgnificanl penalties for submitting false mfomtanon' <br />f <br />k <br />l QFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />O <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED or <br />nowing vio <br />ations- <br />~~auding the pos5ibihty of firtc and imprisomncnt C <br />DE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a-1 attacnmenrs nere~ <br />.J <br />EPA Form 332p-1 (Rev. 3199) Previous editions may be used. <br />'ENT - SEE I. A. i, 17G. 3. FOR REDUIREI'IEN <br />'STt1UC:TI©NS - IC. 1. 7, , PQ. 14. <br /> <br />