Laserfiche WebLink
<br />PERMITTEE NAME/ADDRESS ~ln.-luAr !unlirr \'umr/Lnralinn iJUiJJ'rnn( <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />~~ G .l v +5 <br />1RiVr;~GER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approvetl <br />OMB No. 2040-0004 ~ <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ ~ <br />~~ ' I ' <br />I ~ <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 /> I ~ i <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ' ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I a•rtir~ unAer Ixnulh of Ue Ihal thi. dtKUmrnl and all ~~nacltment+ were <br />rrd w <br />l <br />r m. dirrrtion or w <br />rnition in aarordanae ~~ilh a <br />+trm Ar+i <br />;nrd TELEPHONE DATE <br /> y <br />prepa <br />n <br />e <br />p <br />> <br /> to a>+urr That qualified prnonnrl pnqu•rl~ latlxr and evuluutr the infonnatinn <br /> aubmiu~d. f(u+cd on m. inyuir. of the prr~~n nr Ixr.~~m w bn rn:uta:;e the +~+tcm. ~ <br /> nr thine Ixnon+ dinclh nvpon+ihlr fur eulhrrinK the information. the information <br /> .ubmiu.el h, to the Ix+l n( m~ knuwhdge anA helirf, trix. accurate, and nmtplolr. <br /> <br />Th <br />t there <br />re +i <br />n~avnt <br />rnaltie. fnr suhmiUin <br />; fal+ <br />inGtrm <br />tiua <br />I <br />aM SIGNATURE OF PRINCIPAL EXECUTIVE ___ _ ~ <br /> <br />TYPED OR PRINTED p <br />am <br />arc <br />a <br />a <br />[; <br />i <br />r <br />a <br />including thepo++ibilit/uffineundimpri+onmentforknowin~.iolatiom. OFFI R OR AUTHORIZED AGENT <br />+~ AREA <br />COUE NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />This ix a -~-part fclrl <br />