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PERMITTEE NAME/ADDRESS Untlud~ Fartllt~r.Yame/loration iJlhJJrrsnrt <br />NAME ; S T j1j Y ~{a <br />ADDRESS ~ ' <br />;tl~Ri;E?~'• i?Hs'v'E E. STE X07 <br />:-C1C~D CC 6c711T' <br />FACILITY , , ? <br />'-• T h,E <br />LOCATION t^~~~y~ GO HrJi'f~' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMIBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> <br />,;~ Rt~hii <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~( II~ ~JIS~'1 <br /> MEASUREMENT "~= <br /> = ~ <br />J "r <br />~~ <br /> PERMIT r: r ... .;~ <br />. , <br />: <br />'t v i. <br />. <br /> ~phi <br />f-i <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />MElTITLE PRINCIPAL EXECUTIVE OFFICER 1 a'c,9if) under penalty or law that mi+d~KUmetn a,ul an auachmenN wrre -- _. <br />~ <br />'~ TELEPHONE DATE <br />NA pre{cared undo m) direction ur wper+i+ion in aaaurdunrr with u avftrm derigned ~ <br />~-~ <br />~ <br />•~ ~ } <br /> <br />,~ <br />~ <br />~ <br />- <br />1` <br />^ <br />~ <br />~ <br />+ la acwrr Thal yuaiifird prrv,rtnel pnrperl) gather and e+aluatc thr inrormatiu„ 7~ <br />~__" _ <br />•" ~ <br />'~ <br />"' , a <br />- <br />~ ~ ' <br />' <br />'~ <br />- +ubmitlyd. tln+rd nn m) imµtir) of thr penrn, nr prr+~~m who manage the y+trtn, <br />nndhM rur gntlrrrinp Ihr information. for inGurwtion <br />rsons dirrcUr ra. <br />u <br />thocc _ <br />~_ _ • <br /> <br />, <br /> <br />~ <br /> p <br />r <br />pe <br />I - <br />~ a ~ J ( <br />~ <br />' ~ <br />' , ~ <br />~ <br />~ (i + I j <br />r--- <br />'' <br />~ rte. <br />suhmittrd [.. to the br+l ur nq k,towlcd);c and hrlief, true. accurate, and e~an{, SIGNATURE OF PRINCIPAL EXECUTIVE ... <br />_ - <br />~ <br />. ~ <br />: <br />~ <br />~ I can uwarc that tlmrc orc yi¢nifiaml pamaltir+ fur +ubmining falsr information, <br />THORIZED AGENT <br />FFI <br />A AREA <br />ER <br />YE <br />R <br />MO <br />TYPED OR PRINTED inclWlinq the po++ibiliq or fine and impri++mmmt for knowing rkdutionc. O <br />CER OR <br />U O NUMB A DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re-erence au arracnmenrs nere~ <br /> <br />