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PERMITTEE NAME/ADDRESS ilnclude Facihn dam. („r,un,e iI (hllir,wr, NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No. 20440004 <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 />M <br />> 1 Chi <br />y <br />J, <br />"? <br /> EASUREMENT <br /> PERMIT t: , _P C f ;v :. <br /> REQUIREMENT ;G:. ! ?`•-!r'• - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />R <br />M <br /> MEASU <br />E <br />ENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />i <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />M <br />S <br />EM <br />A? <br /> EA <br />UR <br />ENT <br /> PERMIT , - <br /> REQUIREMENT <br /> SAMPLE <br />M <br />N <br />> 1 rf <br />+rJ <br />t <br />j <br /> MEASURE <br />E <br />T 1 <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT (r <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertif? tntdrr Penaltl of law that this diwo"wnt and all attachment -ere <br />ared <br />r su <br />r, isim <br />e <br />d <br />n <br />i <br />c-da <br />e -ith <br />te <br />desi <br />d <br />di TELEPHONE DATE <br /> - <br />rn <br />pr <br />p <br />un <br />rr m? <br />reen„ <br />pe <br />, <br />n ac <br />nc <br />a - <br />gne <br />V <br />- - .?-r-- ,? <br />. w assure that yualiried pcnnnnel prnlxrl? Rather and e,aluate the inrnrmulion <br />s-bmitled. Rased on m, mgmr, of the persnn -r perm- -hn manage the -trm. - - - -? <br />^? ?~ <br />^- <br />t or those person direct, r-r-amble for gathering the information, the information - - "? - __ - <br /> submitted is <br />to the bts ul nl? kilo-ledge and belief, true, accunue. and camPlete. <br /> <br />- , <br />e <br />ub <br />ralsc• info <br />I a <br />a <br />a <br />e th <br />t th <br />i <br />ndk'a <br />t <br />nine, fo <br />itti <br />mati SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED m <br />- <br />r <br />ere are r <br />g <br />n <br />P <br />n <br />r s <br />m <br />ng <br />r <br />on, <br />a <br />including the IarssibiMN „ t Imr and impriwntueni fur kriMing,iolations. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 33241 (Rev. 3199) Previous editions may be used. !. ; Thi. is a 4-Part form.