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PERMITTEE NAME/ADDRESS Qnclude Facility Nane/Localion iifAfferenv <br />NAME <br />8 r'LLG' ir'1r?-lil ?'? ?' ?? ? .16.I'C . <br />ADDRESS lea <br />>? G;z 60.5 aCON <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />6620 C-2.2 4 1 <br />PERMIT NUMBER DISCHARGE NUMBER <br />/0001, Form Approved. <br />, coRAI I CYO j OMB No. 2040-0004 <br />f A, .r /V o f,. Qd4 ?J?, oo5'A; 008 A <br />A-8.009A RIJ09 00-1-5A oa4,A. <br />FACILITY Pr a,/Y, <v ! Ca`f !? n+(\ MONITORING PERIOD of C, 0 2LO (,,J C-) <br />4 !4 <br />LOCATION ;ed?0? <br />YEAR MO DAY YEAR MO DAY <br />1pN <br />ec?ac? © `? !o 0 9 <br />?a' .N? 2i Cv 8 fC? , <br />? 17- 1 / <br />of <br />? <br />1? <br />f8 <br />NOTE: Read Instructions before completing this form. <br />''QQ <br />aa <br />PARAMETER N11 <br />S <br />? <br />ANTITY 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 /> P <br />T _ <br /> -- <br />ERMI <br />R.?IUIREMENT . <br /> SAMPLE d <br /> MEASUREMENT <br /> <br /> PERMIT <br /> 'REQUiRENE NT <br /> SAMPLE <br /> MEASUREMENT <br /> ' <br /> PERMR° ? . <br /> iIEQUTA?IT <br /> <br /> SAMPLE <br />i <br /> MEASUREMENT <br /> ,• -PIrflMFT .. - <br /> I EGUIRISMENT <br />.. u <br />svx•ii Flw y <br />.• <br /> SAMPLE <br /> MEASUREMENT , <br /> i <br />f <br /> <br />?iEi>IkHRF,MEN t 1.7 <br /> SAMPLE <br />;. <br /> MEASUREMENT / <br /> ` PERMIT <br />. <br /> REQU,IREIENT z:' <br />... .. k <br /> SAMPLE f <br /> MEASUREMENT f? <br /> <'. PERIIIIT _ . <br /> <br />IUIREAEM % <br />( <br /> <br />NAMEnTrLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of taw that this document and all attachments were T ELEPHON E DA TE <br /> prepared under my or supervision in <br />accordance with a system designed <br /> to assure that qualified p?Tsonnel properly, gather and eVa evaluate the information <br />gather - <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br /> <br />' <br />' or those persoas.,direcdy`respoasible for gathering the information, the informative <br />v, <br />rran rg ez <br />a <br />- ,tier submitted is <br />to the best of my knowledge and belief <br />true <br />accurate <br />and c <br />l <br />te <br />- , <br />, <br />, <br />, <br />. <br />omp <br />e <br />1 <br />' SIGNATURE OF PRINCIPAL EXECUTIVE 9? G,?S 43 /v ©1 <br /> am aware that there are <br />significant penalties for submitting false information' <br /> <br />TYPED OR PRINTED <br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREp <br />C E <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANOTIAN AF Auv v1AL ATIONS /Rwfibmn..a an mOnPhrnnn/e h.-I <br />a, '0*n ?i?-l c? v I i?' S r-r.?c f ?vr.J fo r. 'rte /et jrvr , c ???? 1/ <br />