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Pc RMITTEE NAME ADDRESS tln. I ie PacxA xtvne.•L.nation i/DitlennU <br />COMPANY, LLC <br />ADDRESS <br />STP EE T <br />"qI CAD <br />I LITY E L M f N E <br />`JCATION TON <br />P•:F (:OVERDALE <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 />OMB No. 2040-0004 <br /> <br /> <br />PARAMETER •--- • - ,.- ,„auuwwna uet ore co mpleting fm s form. <br /> QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT tI # t a :: y <br />; <br /> <br />VAL..': <br />REQUIREMENT . <br />_ <br />` <br />t?:= <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />11;=t1._,.;:: REQUIREMENT >?t <br /> <br /> SAMPLE <br /> MEASUREMENT <br />= <br />at< <br />, i ?. <br /> PERMIT 't #{i#- <br />L'Jt NT C• : -sere; J -. REQUIREMENT <br /> <br />i :_ P• MC, I <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> _. <br />- PERMIT f <br />. # ? : it # A # # ?'t <br /> REQUIREMENT <br /> SAMPLE j i! .r o i <br />y <br />i <br />- tRl1 MEASUREMENT r <br />2 <br /> I <br />,c,{., <br /> PERMIT RT REP C';' # f #3t-3! #### f 3! ##it# # 77 - <br />`1-LUEr,4 T uP';_: _ -,LU: REQUIREMENT AVG DAILY t'r %T\ <br />I+_ At..! F." SAMPLE r-t tr a r t-: <br /> <br />/ I SUAI- <br />MEASUREMENT :.? *- <br /> <br />]E /_• F <br /> <br /> <br />., PERMIT x t ? REPORT Y <br />_ t <br />E-, <br />- it x r?E ! <br /> <br />.•, s,t <br /> <br />z ..* <br /> <br />; <br />L.IJEN i !r= .... <br />REQUIREMENT <br />` <br />t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I .rmf} under penalty of lax that this di cument and all atmduncm, were <br />7 <br />^ <br />/? d ., ? '- X . f _ prepared under me direction or .urtmision to accurdantre with a ayaem designed TELEPHONE <br />- -"' to <br />s <br />th <br />t <br />i <br />7 <br />d <br />DATE <br /> a <br />sure <br />a <br />qua <br />tf <br />r <br />personnel properl%- gather and evaluate the information <br /> Subm ltcd based on m ingwn of the person or per tin. who manage the ystcrn. <br />or thos <br />di ?.---- <br />•NY? _r <br />? t <br /> e persons <br />rmtlp resptxntblc for gathering the information, the Information <br />submitt <br />t <br />th <br />d <br />f <br />b <br />i . <br />• <br /> e <br />ts. <br />o <br />e <br />est <br />me tnnw ledge ,r 1 bcl <br />cf. tnt.. accurate, and complete • <br /> <br /> <br />TYPED OR PRINTED <br />I am awa e '1 „ Ti t u r c . r pcnaln s t", uhmm tie !also information. <br />meluding •i n_ l .c,inifuc tit hn, <br />t <br />ti <br />• <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHO ! - " ?j ?> <br /> _ <br />,c ,mpn+.mnu <br />nt <br />....?, •, trig vurlations RIZED AGENT AREA NU <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL <br />ATIONS (Refer <br />ll <br />t MBER <br />coDE YEAR MO DAY <br /> ence a <br />a <br />tachments here) <br />AVG. DURING PERIOD REPORTED <br />- DDOO i This, is'a 4-part fonn.