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PERMITTEE NAME;ADDRESS rl.rrlude 1-*a drrv .V',an¢%bwanon if Di,11eieour <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION, <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 />]R <br />13R <br />r IidAL HOLAN <br />r.r rl•r •-rrturh•-'= i•P1 AFrfi W?'.?!-i <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br />i <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAMEMME PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachtnen« were <br />dii-town or superasion in accordance with a syuem designed <br />d under m TELEPHONE DATE <br />l •_ ,, ! .: y Fi y <br />prepare <br />to acsurc that qualified personnel properly gather and evaluate the information <br />•uhnvned. Bascd on my inquiry of the person or persons who manage the system. <br />.maible for gathering the information. the information <br />those <br />crwne directl <br />re. -?? - <br />, <br />J - <br />1 -f y <br />or <br />p <br />p <br />submitted is, to the best of my knowledge and tv beef, true, accurate, and complefc SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that there are significant penalties for submitting fabe mtonnati'm THORIZED AGENT AREA <br />TYPED OR PRINTED including the ju ssibilm of line and inipnsonment for knowing violations OFFICER OR AU CODE NUMBER YEAR MO DAY <br />GUMMr-NI, ANU tAYLANMIIUY yr Ar7r vtvvattvrva <br /> <br /> <br />PAGE OF