Laserfiche WebLink
PERMITTEE NAME/ADDRESS rbteludr fue;lin \um~ 'l ~az+ti~n; i(Nrjlrrnn <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESJ <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElf-ITLE PRINCIPAL EXECUTIVE OFFICER I certih render penau~ .rr law that thi. Arwument and nll utwchmrnb werr <br />d <br />d <br />~ TELEPHONE DATE <br /> ~rq(ne <br />tian ur .uperrisinn in arconlunce with ¢ .~.trm <br />prepared under m. dim <br /> In ¢aurr that yrwli(ird pr•rwnnd pr~prrt~ Rnlhcr and e•~ulu¢te the i¢formWion <br /> whmittcd. Fla rd un m~ inyuin of tlrr prnnrr or pct-..mc whu muwge• the .rc4m. <br /> ur tho4e per.unr dircctl7 rnlhmciblr for ~nthrrinR the in(ormatMrn, the inGrrnmliun <br /> .utwninid i~, w the Ix+l of my knuwiedKc and Iw•lieL Intr. anvrate. and ormplra•. <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> na. <br />I ¢m awurc that thrrr are .ignifwmrt penultir for wbmiuint; (uhc informat <br />.iulutin <br />i <br />m f <br />k <br />owin <br />h <br />i <br />i <br />i <br />f f <br />d i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED ine an <br />wnme <br />or <br />n <br />g <br />n~ <br />including t <br />e pr. <br />b <br />l <br />tr o <br />mpr C D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 IRev, 3/99) Previous editions may be used. T1715 tS ~ ~#-ptiTt 1~OnT1. PAGE <br />