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PERMITTEE NAME/ADDRESS (Inc" Fsc0ryNaaa?L4c.rraw f/D(ff c q <br />NAME <br />ADDRESS <br />J 31 ?ITr'-?Tr. I{I;?MWr', f 1-3 <br />FACILITY MEEKEP J 91 <br />LOCATION h??vl? :11;v4 <br />_A K.ER C0 816, <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM IN'!'DES/ Form Approved <br />DISCHARGE MONITORING REPORT (DARE/ OMB No 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER : i r JC <br />FINAL me <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM _ TO <br />NOTE: Rnld klntructlor» blitfor' cair t jetin9 this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOLI NCY SAMPLE <br /> <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT - <br />- RE°CFIT <br />;A'r v <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -^ <br /> REQUIREMENT <br />NAME/TTTLE PRINCIPAL EXECUTIVE OFFICER 1 mrvfy . penalty o h. that thi s document and all .tlachm ents were TELEPHONE D <br /> <br />prepared under my dlretlloo ov mpe <br />rv1 l in attordanee with ¦ <br />system devitnlB ATE <br />?-- to asst" that qu.Bfied persunnet property gslher and e-W ale the Infornellon <br />s <br />b <br />itt <br />d <br />B <br />m <br />I <br />tr <br />f th <br />d -?' .,i •' -° ?'?----? '- - <br /> u <br />m <br />e <br />use <br />on <br />y <br />rpu <br />y o <br />. <br />e person oc penoeu who mange the system <br />or those <br />ersons direttl <br />res <br />onsible far <br />atherin <br />th <br />Inf <br />tl <br />th , <br />J <br />?? <`" <br />?i <br />! <br /> <br />L p <br />y <br />p <br />g <br />g <br />e <br />e ma <br />on, <br />e Informatten <br />submitted Is <br />to the best of my knowledge and Defier <br />true <br />aastnte <br />and <br />l <br />t ?• <br />_?C, <br />. ) r I ??I? ??' f <br />1 1 <br />y / /n l L- <br />- <br />' , <br />, <br />, <br />. <br />comp <br />e <br />e. <br />I am swan that then an significant penalnn for whbmltnng hbe Infornrllae <br />SIGNATURE OF PRINCIPAL EXECUTIVE i? <br />/ o C- ? <br />TYPED OR PRINTED , <br />InAoding the poasiblllty of fine and Imprisonment for knowing violatlor? OFFICER OR AUTHORIZED AGEIFT CODE NVMBER YEAR MO DAY <br />CUMMCPI 15 Ar4U ItArl-Ano-t I IVfn yr nn r . rv?n I IVf7D Irrtrrnren C• Sn NI'MCflmints noral <br />-- I. B 1. <br />T. <br />OEN <br />Tills is 14-part fbfi . PAGE OF