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PERt1IriEE `v t. T. .. <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />i L cr:.. _ <br />DISCHARGE MONITORING REPORT (DMR) - <br />PERMIT NUMBER DISCHARGE NUMBER F* T !`JAI- <br />MONITORING PERIOD FOR 001A <br />YEAR MO DAY YEAR MO DAY V <br />FROM TO X <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />- PERMIT <br />" REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , . a <br />_ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s -07 <br />L• `- , . _ • : REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t: r ! , ;: s_': f i - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT `i iY <br /> REQUIREMENT <br /> SAMPLE - . r , . <br />0DA?t 'd I A Cti MEASUREMENT <br /> PERMIT <br />-' x1`•=P1TG DiLCr' REQUIREMENT t`ll`c VAL-',' <br /> SAMPLE ...t: <br />_ MEASUREMENT <br />PERMIT <br />L- <br />t_ <br />REQUIREMENT - `• - " <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I =mty under penalt? of law that this do. umrnt and all :utxhments Here TELEPHONE DATE <br /> <br />e,. r pared under my direction or supeni rat in accordance with a s.,tcm designed <br />to a +urc that ymhlied personnel properly gather and cti,du:nc the mtonnauun 1 <br />- - submitted Raced on m), inquiry of the person or persons who mana <br />e the >viacm <br />- g <br />. <br /> or those persons directly resp.msible for gathering the mfirmanou. the mforrttatum <br />i suhnnned is. a, the hest of ins knussledge and belief <br />true <br />accurate <br />afxl complete <br /> . <br />. <br />. <br />I <br />n: <br />s-an_ that II• <br />rr <br />arc <br />nii <br />xn: <br />lti <br />itti <br />i <br />f <br />b <br />f <br />l <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED , <br />. <br />. <br />e <br />p <br />ir <br />pena <br />or su <br />m <br />ormat <br />es <br />ng <br />a <br />se <br />n <br />on. <br />din mr Iw ..,h,;,n .,1 this imprisonment for knowing sinlanons. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />CODE <br />YEAR <br />MO DAY <br />.1 IQ r, PTP <br />EPA Form 33241 (Rev. 3;199) Previous editions may be used. 00209: .' This lS,a 4-part f6mi. PAGE •-17 OF