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PERMITTEE NAMEiADDRESS,/,:, tr,d- Furl;tn ,,,,, - - aline IJI?ijJe»•rtri NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />c <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />,r <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT -? -F <br /> <br />- REQUIREMENT <br />`_ a F+ .. <br />tom; "; <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />L I REQUIREMENT <br />- <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT _ n <br />I REQUIREMENT r <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT r 'r <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />- MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />f SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I ccniA under penahs of Law that this dx rnent and all attachment. r:c TELEPHONE <br /> <br />" - - <br />preparatil under ms Jtmuon or atper. tsiun m arrordvmc .vtth n s?,trm rJorgncd DATE <br /> to assure that qualifiLd personnel pri)pcrl% gather and evaluate the mli•mmtion <br /> submitted- Based on mN mqutr) of the person or pemire, who tannage the, ystem. <br />• <br />- - <br />- or those persons directly res{mastble for gathering the niforttnuon, the infomtatton ???" <br />- "' <br /> submilt d t to the best of my kn l d e and Itehci true aceurat and complete. <br />h <br />I <br />SIGNATURE OF PRINCIPAL EXECUTIVE _ <br /> <br />/ s <br /> a ;h tfi am <br />„r a r il ? 1.'r 6tt ng false informamm, <br />TYPED OR PRINTED <br />_ mrl.i t MI ,. f (m ,.r,.. t, r nu i rmg si 1an.,n, OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO <br /> <br />COMMENTS <br />AND EXPI ANATION OF ANY VIOI <br />ATIONR 1RPfarnnra all aHarhm nfc 1--I <br /> <br />CODE DAY <br />I (Rev. 3,99) Previous editior <br />0 r This is a 4-part furor.