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PERMITTEE NAMEiADDRESS ti„ ;,.4, Fin-din- Nam,"l-warunr i(Difjerenp <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. 20440004 <br />iWLAN t <br />NOTE Re d Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF <br /> <br />ANALYSIS SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br /> <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Leritfy under penalty of law that this d,n ument and all attachments were <br />repared under my direction or supervision to accordance tyith a system designed TELEPHONE DATE <br />- <br /> <br />- p <br />to assure that qualified personnel properly gather and evaluate the information <br />submitted fused on my inquiry of the person or persons who manage the ystcm. <br />the information <br />h <br />Information <br />bl <br />f <br />i <br />th .1 - <br /> <br />-?' - ? - <br /> . <br />e <br />or gat <br />er <br />ng <br />or those persons direcUg responsi <br />e <br />submitted is. to the best of my V notylcJgc .Ind he liel'. true.,keurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />t _ <br /> I am aware that there are %iimificam penaltic? for submitting take mlonnanon' OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED OR'"PRINTED ncluding the pn.iMlih of line and impns mnnnt for kna rwm,g uolnhoro CODE <br />COMMENTS AND EXPt.ANAI IUN OF ANT VIVLJ41 rvlva (rTrre+vrra,a an a.aoa ,•••• • • i <br />PREC IP F")F'. `•IT SEE I- A <br />>1f?Pl_] NG INSTRUCTIUN5 - I <br />EPA Form 33241 (Rev. 3199) Previous editions may be used. <br />FOR 1 <br />14. <br />ThiY is'a 4Tart harm PAGE OF