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~ERMITTEE NAPAE/ADDRESS Qnelude Facility: Name/Location ifD~erent)
<br />SAME
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<br />°ACILITY - '
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<br />NA710NAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE$)
<br />DISCHARGE MONITORING REPORT (DMR)
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ,_ ~::: C) . TO . ; CJ : 3
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />iVOTE: Read Instructions before comDletina this f©rs,~.
<br />PARAPJiETER i
<br />QUANTITY OR LOADING
<br />QUALITY OR CONCENTRATION NO. FREQUENCYi SfLhAF'LE ~
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<br /> EX TYPIT
<br /> I I ANALYSIS
<br /> AVERAGE ~ MAXIMUM UNITS MINIMUM AVERAGE iL7A?:IMUM UNITS ~ ~
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<br />IP~ME,/TiTLE PRINCIPAL E~£Et:,UTIVE OFFICER
<br />T certify under penalty of law that this document and all attachments were ///'''
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<br />TELEPHONE
<br />DATE
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<br />~ `~~~ T~~s~~ l ~ ~ ~ .prepared under my direction or supervision in accordance with a system designed
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<br /> submitted is, to the best of my knowledge and belief, tree, accurate, and complete.
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE ~„ 7 ~ t_
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<br />iYWEID OR PFi9i'JTED am aware that there are significant penalties for submitting false information,
<br />includin the ossibili of fine andim risommentforkno~s+in violations.
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<br />OFFICER OR AUTHORIZED AGENT -
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