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PERMITTEE NAMEIADDRESS (Include F'uciGtc.?'omdlc+rarion i/Uiffornt( <br />NAME <br />'1 I h4 ?' <br />ADDRESS <br />!;--:T'F 2[ <br />FACILITY r. <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 O DAY <br />FROM TO <br />M I NUt <br />Form Approved. <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE , <- ,? . ?(D j l r1 ?t T?J <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT } <br /> SAMPLE !-?7r13 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />< <br /> MEASUREMENT -- <br />- 7 <br /> <br />PERMIT 7 177 <br /> REQUIREMENT ta', t.; ?'I .r ; i t <br /> SAMPLE <br />r <br />i ) <br />C <br />L 1?11g <br /> MEASUREMENT :? <br /> PERMIT <br /> REQUIREMENT :.t• 'Tf' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,r t is -: f •:; _ ?. L• <br /> REQUIREMENT - DAILY <br /> SAMPLE iJ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE 0 f u /J" I I? Ihl S <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I vertu) under penah t law that this ch,umrnt and all ulmchments were ??- TELEPHONE DATE <br />Prepared under my 1-, tion or,urwrsicirm in accordance with a v. strm designed <br />In assure that qualified I-nnO properly gather and c,aluate the inrormalion ? <br />.ultmitted. Based Vn ,,,, imtuin of the pe-n or pa•rsr n, wbo mamge the as Hem. <br />-?-- -"- <br />or three pcr,ons dire dt r,,Iatasibie for gathering The inrorn tion. the information <br />L_1 C t. ?'? ubmiard i., to the b.. -I (m. Anowledge and Whet. true. accurate. and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 um aware that ther..in ignirirant penalties for submitting false information. AREA <br />TYPED OR PRINTED including the ptt<sihiM, •-t fine and impriamment tor I.nowing tiolations AUTHORIZED AGENT <br />OFFICER OR DE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />' ('ftFC7P SEE I. a. , P6. 4 FOR REQUIF7EME1? <br />X007 1 Thies'm a 4-kart form.