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PERMITTEENAME/ADDRESS,!,:,!„deF,uilirntvumeT.c x,&nrjDijff,,,,) <br />NAME <br />ADDRESS. <br />FACILITY <br />LOCATION <br />? S I C_t'cl <br />1/-1 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />FROM Form Approved. <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MYE <br />AR DAY <br />OMB No. 2040-0004 <br />RVL AP <br />NOTF• Rpari Inctriii- innc Kofnr,a n.....nlnfinn Chic form <br />PARAMETER QUAN TITY OR LOADING Q UALITY OR CONC ENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS TYPE <br />SAMPLE <br />~ <br />MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br /> <br />SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT i t <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br />_ MEASUREMENT <br /> PE <br /> RMIT <br />- 1_ ;j REQUIREMENT _ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PER <br /> MIT t -: rta .t t -: <br /> REQUIREMENT <br /> <br /> SAMPLE <br />r MEASUREMENT <br /> ER <br /> P <br />MIT ; ;c r.,,• :: : ` ,4 R1 <br /> REQUIREMENT ar . <br /> SAMPLE <br /> MEASUREMENT <br /> PERM <br /> IT ' E 1= L R T F c' -,;, ! c <br /> REQUIREMENT <br />NAME,/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all amw1urienrs were <br /> <br />- <br />prepared under my direction or supen isaon in accordance with a system designed TELEPHONE DATE <br />T , to assure that qualified per,onncl properly "ther mid evaluate the information -- - <br /> suhmita-d Based on my inquiry of the per.on or persons who manage the .,}stem. _ r -- <br />- or those persons directly responsible for gathering the information, the in(imrmion <br /> subi-mted is, to the lx.si of my know lc& and hrhef w xcurate. and complete <br />SIGNATURE OF PR ? - <br /> <br /> <br /> <br />YPED OR PRINTED l am aware that there arc mgmficir, rt,o <br />r t . ,V n <br />i e false information, INCIPAL EXECUTIVE <br /> <br />` <br /> n.{oding the possibility of nn r J! ",,w t, ki ing.wlations, OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL <br />ATIONS (Reference all attarhmnntc haral <br />CODE MO DAY <br /> <br />- - 5 ed rc)r,s may be used. ? This is a 1-pact form.