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t,>!WTTEE NAMUADDRESSl7"d--%«, r..ti'.w?t--:::.. _ <br />NAME <br />ADDRESS <br />FACILITY - <br />LOCATION S +Y O <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDES/ <br />DISCHARGE MONITORING REPORT IDMRI o 2040-0004 <br />'I <br />PERMIT NUMBER DISCHARGE NUMBER <br />F?PaAL r-ICF47' <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY ?•'' ~'' rev" ?'' ' "? '' "? "' '? ? C r `fib <br />FROM TO <br />NOTE: Read kt•tructiom before corh?oletlna this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br />, <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <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 />NAMEMTLEPRINCIPALEXECUTIVEOFFICER "rt""y" rpt""col..that thbdotvme"i .rw.Il.tt.rnme„LSwen TELEPHONE <br />_ <br />pnpand under my dir'rtlon or wper.hlon In.trord.ntr with • system ddgnnd - --? - '? DATE <br />Y <br />t/L1 <br />r <br />- to assure that qu.Iln d persennat Pro"Ay gather and tt.lu.lt the Inrorsn a lon <br /> <br />I <br />i <br />h <br /> <br />.. nqu <br />.ubmttrd. Bend on my <br />ry of t <br />e person or persons who manage the system, <br />l <br />s <br />lbl <br />sh <br />t <br />f <br />,??--?? <br />- <br />. <br />? i 1 y rr <br />pom <br />or <br />ow person d <br />rscs <br />t <br />or gathering Litt Information, the Info lMn / <br />C- V (?:?1• 1-j" t,J ?f J <br />` <br />' <br />• <br />J '/ <br />y / <br />•_ f [- v C ,' i r ; submitted K to the bet of ms ?nowl dtt and beMtf. Imt. at--i" and tompktt- <br />I ...... that then .n stgnlffrant penaltle for mbmltttng f.I* Infonoadon <br />SIGNATURE OF PRINCWAL EXECUTIVE I /C- <br />, <br />/ i <br />1L 4 ! ' <br />•/ i? L C <br /> . <br />t <br />f B <br />i <br />ll <br />d I AREA <br />TYPED OR PRINTED ne.n <br />1-fad <br />ng the poWb <br />l <br />y o <br />nyrbonmtnt forknow Ing .Wst,! r OFFICER OR AUTHORIZED AGENT CODENUMBER YEAR MO DAY <br />L.UMMCP/ I J APIU CAV`-L.AMn n 1-1. v. na r rw?n , ,vn? Irrgr,wrv n:w wn wnwcn-nonce nwrq - <br />'4HR PPECIP EVENT i5 CLAIMED. IF CLAIM AFPROVED BY WKD, <br />ED 1EASQF.ENEN'TS - SEE I A. R, PC, 3 FOR BURDEN OF PROD-' <br />1 . ?_ l . LS , rte. 7. D 1 C A I"IJIN , UJM I INky r% =%I J./ 'JINL- T 1 PACE ? <br />MS iS a' 4-pbn form' ' <br />J. - . <br />0010,