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PERMITTEE NAME/ADDRESS iInclude Pandit)Aamrl b caru.a it Uify,rr:u <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO L_ I <br />Form Approved. <br />OMB No 20400004 <br /> <br />NOTE: Read Instructions before completing this form. <br />OUTS <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br /> <br />OF <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a I - •. <br /> REQUIREMENT .,ODA A'.)"- 91 ATLY MX <.IVNUA <br /> SAMPLE <br /> MEASUREMENT _ <br /> PERMIT - , <br /> REQUIREMENT <br /> SAMPLE <br />- <br />f <br />-k 1 <br /> MEASUREMENT <br /> PERMIT r a. .- <br /> REQUIREMENT <br /> <br />SAMPLE <br /> <br />- <br /> <br />" / t <br />A <br /> MEASUREMENT - - <br /> PERMIT j - :, <br /> REQUIREMENT : , I ! -??;'dt_IA <br /> SAMPLE i <br />(. <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT SODA <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT k a I. r s <br /> REQUIREMENT \•'G =,; 1I_.Y ?,P4NUA <br /> SAMPLE <br />I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT Y MX <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certih under iienall, of law that this d,numrni and all aitachmrm, were <br />- ? TELEPHONE DATE <br />_ prepared under nn direction or supervision in acrordaurc w ith a ,stem alwigmd " <br />1 <br /> to a-urr that gtaliaed pe-m rl pn,perh gather and evaluate the information <br />. wh <br />n <br />rn <br />R <br />i <br />f <br />h <br />th <br />t -' <br />-- <br />" <br />--? <br />- <br />/ e pe-ti or person <br />o ma <br />age <br />e - <br />. <br />suhmilt vf. <br />ie-d on m, <br />nquiry o <br />t <br />e _ <br /> or thse persons diracth -tionsible for gathering the information, the information -- ''--- -- , <br />+l ` <br />C a=" submitted h. to the ht: t of m, knowledge and I+elier. true. accurate, and complete- <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />`- <br /> <br />TYPED OR PRINTED I :un aware that there an ?iFnirlram penalltea for submitting fake information. <br />including the p,nsibility of rtne and imprisonnwni for knmwing si,datiorts. <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 33201 (Rev. 3199) Previous editions may be used. <?OG'. nis iS a 4-dart P6nn.