Laserfiche WebLink
PERMITTEE NAME/ADDRESS(lnclude Fociliry NamNlocanon tfDil(ereny <br />NAME <br />~ L- : ~i l 1:. :. a <br />r'. ~. "~.1A :r' i <br />FACILITY ~ ~ I ` ' ^ I ~ ~ <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FOfm ApprOVed. <br />DISCHARGE MONITORING REPORT (DMRJ OMB No. 2040-0004 <br />' i :, _i ± <br />PERMR NUMBER DISCHARGE NUMBER ( _ .. ~ <br />MONITORING PERIOD I'~!'~ = + l i T:, _I i . t? r. •_; :; !~ ; fi L~_' <br />YEAR MO DAY YEAR MO DAY __ <br />FROM ..1 h:; it TO 'J, ,)• ~ .. ., :;J ~.:. .. r. ,; ~~-: <br />unre. o....w u...:.,,.a~..... ~...~,. ~.. ~~ ~.,t,..i.... ILIA 1....., <br />c . r <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br /> EX of TYPE <br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ava.rsts <br />'~ ~1 SAMPLE . ' ~ x :::: ., .... r ;r n t~ <br />g <br />S .. <br />8 <br />~ ( <br />~ <br />G / <br />I <br />/Ali/T~r <br /> MEASUREMENT . , <br />..J l'.1 i I '1 :;" ~ ~ <br />~ <br />~ °~ ~., ~44s#Ys~ ; ,+ <br />~ e F;F'LY -~CS~ITU <br />-"7':,u.::T t,:'J" Ja;.u. ~ <br />REORR ~ <br />~ ,''~.i`i ~ <br />, <br />'~~" "' '~.~ , <br />. <br />,,~, F1 ii.< -, <br /> SAMPLE <br /> MEASUREMENT <br /> <br />~~ <br />M <br />; <br />? <br />~ ~" ~ <br />i <br />~" ~ x <br />>F ' f ."' <br />_ <br />_ <br />I. <br /> (\~~ <br />y~, <br />~r~~ ~ s . <br />, <br />. A <br /> ~ <br /> SAMPLE <br /> MEASUREMENT <br /> }'~ <br />. <br />~ by! PV•~.,1 t v "~ ,4 ~S ~{ YAY j t. <br />i .. <br />~ ..:':t ~ <br />~ n ,. .. .,\ <br /> <br />4. ~-, <br />:,~ <br />hJ MAY 4 <br /> r + <br />t ~,. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> r t ~ <br />yet L <br />l~" <br />dy: F~ <br />~, ~• <br />trv. <br />T~ .. <br />' <br />q P <br />~ .t . <br /> 1 !i ~.." ~ <br />h ~' rN. <br /> SAMPLE <br /> MEASUREMENT <br /> v: <br />kY <br /> <br />,... <br /> g . <br /> SAMPLE <br /> MEASUREMENT <br /> <br />r <br />r+ <br />~:;: <br />°' <br />: <br />+ ?r <br />r <br />' <br />k ,".S . r aa~p <br />. `+ <br />'S'W"' <br />'~ <br />.. <br /> DrhrlrneN <br />lCart.: w . <br />µ <br />,..: ,~ ATt,. <br />•° <br />,.+ Y <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Cerdry unoer penary rn law that Mis document end ell enacnments were TELEPHONE DATE <br /> prepefed under my tlire~tion or supeMSion in accordance with a system designed <br /> <br />' b esaure Met qual~fietl personnel properly gather end evaluate Me inbnrtelion <br />eubmNed. %sed on my Inquiry W Me person a pereone who manage the system / / b- _ _ <br />~-` ! ~/' ~ <br />r- <br />a <br /> <br />r <br />w. cis 1 <br />~ J :l P•' T ~ L:+ , <br />tl <br />l <br />tl <br />l <br />l <br />b <br />h <br />d <br />M <br />b <br />M <br />hA v ~ ~)-~ = iI ^ ti ~U l U 1 U) ^ . <br />'. <br />$$far..kk9i t~T+~ %~uell~~C:~ ,;:st.d~tT orma <br />an <br />or Moss persons O <br />rec <br />y rospona <br />e <br />r gel <br />e <br />ng <br />e Inbmtel <br />n, <br />e <br />b <br />euDmittedla,toMebeetofmyknowledgeendbellel,true,accurate,endcomplete. SIGNATURE OF PRINCIPALE%ECUTIVE <br /> <br />TYPED OR PRINTED I am ew2re Mat Mere era atgnHlram peneltlee br submining lake inlormation, <br />Incluainp the noselblliN Of gne antl lmoriaonment forNrowlrq violations. OFFICER OR AUTHORIZED AGENT <br />rnnF <br />NUMBER <br />YEAR <br />MO <br />DAY <br />CQMMENTS AND EXPLANA710N OF ANY VIOLATIONS (Aelerence ell attachments here) <br />Z~~'j ~ i~i"A:, a'):i LI']i'C': . fL:. _.. ,_ .. ~ f ~i. ;.rrl'n L' ~~ ~L1: ,; .. 1:..: ) ! ~ _~ ~ r .,- <br />SFE fiUhL: ~ J"r' YHC~JF P,C1JItit:;S.1T_; ii'.. I. p. i. FtFI:"' ryll"•I .,.-. _.. - ... ~L ~ .. ':C <br />P orm 3 ~ R revlous edi Ions may a use ` ' - ~ ~ " ~ ~ ' ' ' ' ~ ~ , ' , T~iIS IS A 4-PART FORM PAGE ~ OF <br />• _. .,, <br />