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Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPL%ES) <br />PERMITTEE NAME/ADDRESS (ymrVLf.cehryNanuvL rwi- V` (,%,-') DISCHARGE MONITORING REPORT (DMR) <br />NAME <br />ADDRESS PERMIT NUMBER OISCHMI6E NUNABER F I N <br />L !W TF TO <br />',i I A MONITORING PERIOD _ <br />FACILITY I E NO. 2 M I I 1 Y R M0 DA YE R MO DAY <br />LOCATION NIA FROM TO <br />NOTE: Read k?atruetiofu b'010r* completing <br /> NO ?E oFNCY SAMPLE <br /> CONCENTRATION <br />O . <br /> QUANTITY OR LOADING <br />? QUALITY <br />R <br />EX <br />TYPE <br />PARAMETER ANALYSIS <br /> >< MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> AVERAGE <br /> SAMPLE <br />G- <br /> <br />- <br />- <br /> MEASUREMENT <br />7 <br />T <br />UMFUI- <br /> <br /> PERMIT ; , '.#'?•# ###### sr <br />30DA AVG - <br />Mx 7G tVw <br />r'tr <br />i'iC)tvTtl <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT 77 -is <br /> PERMIT :. , 7 'C; A AG 7D AV - _, Itl <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT J. . z - :. <br />1 <br />MAXIMUM <br /> REQUIREMENT M N <br /> SAMPLE <br /> MEASUREMENT , <br /> PERMIT <br />: Fti t'?Vt? <br />:: <br />11)( :'D AV <br />?`?iTH <br /> REQUIREMENT <br />. <br /> <br /> SAMPLE - <br /> <br />MEASUREMENT <br /> <br />45 El <br />t <br /> PERMIT 30I}A AVt; 7D AV TH <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />'2 1 PERMIT INST MAX .. Vr?.y r <br />1EN'I s REQUIREMENT <br /> <br /> SAMPLE <br /> <br />MEASUREMENT _ <br />- 0 PER <br />AVG: U?gTI 1' rri'r <br />- <br />i` <br />_ IJOt.' -- <br />, <br />r <br />i <br />REQUIR. <br />e TELEPHONE <br />w <br />t DATE <br />er <br />s <br />pen. h o bw tMl tAh document and all .1whmen <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER r my direction or wrprvf/on In I rd.,,m with • sy.lem ddtned <br />NigR <br />u.llned personnel properly gather and e•.Iu.te the Information <br />uiry of the person or persons who manage the tyit m. . <br />In <br />n m <br />ed <br />y <br />q <br />o <br />f <br />rrallori <br />ti <br />!M I <br />I <br />f <br />on. <br />n <br />or <br />n <br />orma <br />dimity mpondbin for tethering the <br />and complete. <br />d beef <br />true <br />arc'um'r <br />k <br />el <br />d <br /> . <br />, <br />. <br />ne <br />e <br />ge an <br />sub mined h, to the best or my <br />m ware Qat there .re sltrJftc.nt pendtfes for wlbmlltlnt tabs Inforrtrtlon, <br />I SIGNATURE OF PRINCIPAL EXECUTIVE <br />T <br />AREA NUMBER <br />YEAR <br />MO <br />DAY <br /> . <br />ncludlnt the powelbility of fine and Imprlsonmmt for ?no.ing ` olatfom AUTHORIZED AGEN <br />OFFICER OR CODE <br />TYPED OR PRINTED <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Roforenc• an •rracnmenro nerrer INSTRUCT 101 <br />JC) is)isi4-part;fdrttt. <br />nzlrLt rR- 3 .99! Previous editions may be used