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PERMITTEE NAME/ADDRESS (lwota4frWryNw?L.xar°.1/D(P-) <br />NAME <br />ADDRESS iJL_Uv.Y _: <br />X7:31 raZ T HT^_HWAY <br />11FEKER co 8!642 <br />FACILITY Y 0 <br />LOCATION IKE- R <br />UU $184'i <br />. • \, - - t •n NZ= iR C?C <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FR(OUENCY <br />OF SAMPLE <br /> <br />YP <br /> ANALYSIS T <br />E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />S <br />M <br />N <br />O `? <br />l <br /> MEA <br />URE <br />E <br />T <br /> PERMIT i <br /> REQUIREMENT <br />MAY., T Mum- <br /> SAMPLE <br />MEASUREMENT <br />`-- <br />J <br />- <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT Z L <br /> <br />- (7 PERMIT E!' L' R F f' C]F i <br /> REQUIREMENT <br />4C`06 AVU DAILY <br /> <br /> SAMPLE <br />NT /1 I <br />l /S r /i <br />(f f " <br /> MEASUREME <br /> <br /> PERMIT <br />T s?,. I Q EZEI'CrRT <br /> REQUIREMEN <br /> SAMPLE <br />MEASUREMENT :• <br />v - _ <br /> / <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i• y :T;. y ?r?c <br /> <br />- REQUIREMENT <br />i , <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER t "rt"y under Penalty ° Is- that thh document and aN attach-0 wen TELEPHONE <br />Prepared under my directton or uperelslon In accordance with a system designed n <br />A ! j y L ± to aaun that quaNn d personnel properly gather and e•aloatr tM Informatloo <br />, <br />r DATE <br />/ <br />submined. Based on my inquiry of the person er penoen wbo manage the ey,,,m. <br />% <br />! '• <br />n .. ?` x <br />l l or thuer prrsorn directly mpon/ble for gathering the Wormatinn• the Inrorwrlien <br />kn°wled <br />r <br />( <br />i <br />' <br />wbmltl <br />to the ties, or m <br />li <br />d h <br />r a <br />d b <br />f <br />t <br />v <br />l <br />a <br />t <br />c " J ?7 l /J <br />d <br />l c r <br />I• J <br />/ <br />? <br />? f <br />5cc? <br />; `_ <br />y <br />t <br />e <br />. <br />n <br />e <br />e <br />. <br />rue. acc <br />n <br />e, <br />comp <br />e. <br />n <br />e <br />bmittin <br />Z 1 am 0--r' that them .n dgnllkwnt penalties for s <br />raise Inf <br />SIGNATURE Of PRINCIPAL EXECUTIVE <br />ti <br />n <br /> g <br />. <br />u <br />orma <br />o APIA <br />TYPED OR PRINTED Incbdbrg the poalbraty or fine and Imprisonment for knowing Oolatlom. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference eN attachments here) <br />`iET APPL +-f IS ,ED. IF CLAIM APF- <br />TS`= ; . J?!.I_ I'JUT D:_ :3 - SEA ?, F'C' :3 F IMF. PURR: ' <br />h <br />Ed?1 Forrif 33 0 1 (4C . 31W Previous efir6ons`may be`uaed is is'a 4-pert TOrITI PAGE Of