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PERMITTEE NAME/ADDRESS (Include ParUur N'amr1 otadon if Different <br />NAME <br />ADDRESS <br />^I { i 4 c <br />- - <br />FACILITY HEN; !. Z- Zia ('i i t. i <br />LOCATION A 1 4c <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL <br />t_^rf9.MTrsfT= f- <br />MNTR5 <br />NOTE: Read Instructions before completing this form. <br /> NO FREOUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . of <br /> EX LYSIS <br />N TYPE <br /> A <br />A <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />L <br />RE": <br /> <br />E <br />71C <br /> REQUIREMENT <br />;_i t, '?eJ - <br />i)RI <br />"tC1PI'I <br /> - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT sr: :-j T- - FiCisfrF('. =17 <br /> REQUIREMENT r'' * T I <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT =.Vt; ij? <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 /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certih under penalte of law that this dueumcni and all attachments were <br />TELEPHONE <br />DATE <br /> prepared under m) direaliou or supe•nision in accordance with a system designed <br /> to assure thut qualified personnel properh gather and eealaate the information <br /> submitted. Hated on m) inquir) of the person or pervnav who munage the.)slem, <br /> erson, dintitl) resgmsible for gathering the infor nali,m, the information <br />or th.ne <br /> p <br />%uhmitud is, to the Ma of m) knowledge and belier. true. accurate. and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that there are significant penaltk for submitting false information. <br />A <br />EN AREA <br /> nt for knowin <br />violations <br />d i <br />riso <br />r f G <br />T <br />OFFICER OR AUTHORIZED <br />I <br /> <br />DE NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />TYPED OR PRINTED . <br />mp <br />nme <br />g <br />ine an <br />including the possibifil% o <br />COMMENTS AND EXPLANA I IUN Ur• ANT vluILA t IUna tnefererfce all allal,.....e..ea --j <br />00054