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PERMITTEE NAME/ADDRESS rlnclude Furibry.\'umell ittion iJltifjrrrito <br />NAME <br />ADDRESS <br />s. L'7X h•28 <br />F: LA CC v i <br />FACILITY ) K)R F ZON M I t-Jt= <br />LOCATION L A ?, I' J S I <br />LAI•JCE WADE, NfIi•JE I"IAI,4AGER <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 Approved. <br />ONIB No. 2040-0004 <br />'OR <br />IBR MH ) <br />. FTNAI MNTRS <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <Et_: fl -, <br /> REQUIREMENT TJDr MG? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : ?- e !: s ;': ? t lR T <br /> REQUIREMENT Dri I ?_ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT RF('ivRT 19 P0r-7 <br /> REQUIREMENT :C_lLif1 r;V y ' i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i ,-. <br /> REQUIREMENT '30D <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT ` <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I error) under penaln of law that this document and all attachment% were <br />d <br />h <br />d <br />d <br />di <br />i <br />i <br />i <br />i <br />t <br />d <br />i <br />d TELEPHONE DATE <br /> rection or uprrv <br />ance w <br />a sys <br />gne <br />pnparr <br />un <br />er nn <br />s <br />nn <br />n accor <br />t <br />em <br />es <br /> to assure that yualifinl personnel pn,q•rly gather and rsaluae the information - - <br />- - ----- _ submill vt. Bawd on my inyuin ref the In- or per,rms who manage the system. _ <br /> or thou pawn, directly re,pomible (or gathering the inrurmatirat, the information - <br /> ubmittM is. to the best of my knowledge and belief. in.. accurate. and armldete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that them are significant pcneltic. (- ubmittoi, Gd.e infornmtion. <br />OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including the prn,ibilin of fine and uup r.nuwrnt 1, knowing sirdatium. D NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 33201 (Rev. 3199) Previous editions may be used. 00081-• . ' Th1i&;§7'iir-4-0ant' f4tn•