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' « ^^"'r:i.?vamcaa ff'?'?'?riw•OaryN?¦rL¦rw/an I/D(Olr.s.r) NAME NATIONAL POLLUTANT 04SCHMOE ELIMINATION SYSTEM /INPDE3/ Form Approved. <br />DISCHARGE MONITORING REPORT OMB No 2040-0004 <br />ADDRESS <br />iz t.j PERMIT NUMBER ascHMOE NuMeER <br />!iA <br />FACILITY ' - MONITORING PERIOD INPlI 7F I <br />LOCATION FROM YEAR MO DAY TO YEAR MO DAY <br />' R 1 - - - _ <br />PARAMETER NOTE: Read Irtstrvctlor» before complotlnp this form. <br />QUANTITY <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />ii NT <br /> r-1 !7 <br /> <br /> <br /> OR LOADING QUALITY OR CONCENTRATION NO, I'MOUENCY SAMPLE <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS OF <br />EX ANALYSIS <br />TYPE <br />SAMPLE <br />MEASUREMEN <br />PERMIT E <br />REQUIREMENT <br />SAMPLE <br />AX I MUM <br />MEASUREMENT <br />PERMIT <br />RE a it#{ is ; <br />QUIREMENT NCE/ RAll <br />SAMPLE <br />_?I)?: r1?? <br />U/i1LY rfY <br />MONTH <br />i <br /> <br />MEASUREMENT <br />PERMIT <br /> <br />REQUIREMENT 'OF" -" REP Oh! <br />n <br />JL = ; <br /> <br />I <br />SAMPLE 1 A. ,,• DA I I- V MOrIFT H <br />MEASUREMENT _ <br />PERMIT <br />REQUIREMENT <br />- ! 7G <br />f 1 :_ <br />1 NC: <br />i - <br />SAMPLE .30DA AV" J?1 i i" r i•• , MONTH <br />AEASUREMENT ?.r. <br />PERMIT <br />' <br />REQUIREMENT : i r. <br />. a• tE ON I <br />F - <br />SAMPLE j 1 r.;FI:S ;: - r.ESJ I <br />fEASUREMENT <br />PERMIT <br />tEQUIREMENT EP OR,' <br /> <br />7 <br /> <br />77- <br /> -! D?AILY MX <br />SAMPLE <br />IEASUREMENT <br />PERMIT <br />EQUIREMENT <br /> <br /> <br />fubmlllyd. Batted on mr Ingvlrr of the ptnorl a Perm oho m Aare the 0ntem, <br />or 11100, pr 0 dlferlle f-Pontlbk for g¦Ih,ring the Inrornullon• the I.("a- <br />¦ubm111ed is. to the bnl or mT kn j dg, and b.W. Irv-, bMt-11, and -mpk/e. <br />1 am ¦.¦re that there are 01lMfk¦nt Pen¦Itlo for mbmltdns rat" Infonn¦tlen, sIONATURE OF PRINC'IRI L El(ECllTtNE <br />TYPED OR PRINTED Ilrivdlntt Ow po¦0lbllllr of 11- and Impr4¦0nmenl ror kno.IM W.Uom OFFICER OR AUT}iORIIEDE AGENT A A NUMBER <br />OMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference &/l attachments here] CODE YEAR ;MO OAY <br />?A .. ?:.'? ? ?. 359. Prr.;o.,5?- - .... •;. <br />This is a J-part form PAGE of <br />- - - A