Laserfiche WebLink
°orm Appro:ea <br />PERMITTEE NAMEJADDRESS QweL~eFrihry N../[,ocnrart I/D~irmq NATIONAL POIIUTANT dSCHAROE ELIMINATION SYSTEM NPDESI uME !Jo 2C4C-0004 <br />NAME DISCHARGE MONITORINt] REPORT /DA•IRI <br />. `- <br />ADORESS _ _ <br />• C li A 1 ~- - PERMIT NUMBER dSCHMOE NUMDEII <br />~ A t) ° - MONITORING PERIOD <br />FACIIfTY <br />;~ .r. U Y. 2+ ., :::. ~ , . _ YEAR MO DAY YEAR MO DAY <br />LOCATION t' k L I :: A C '~' ,. _ FROM TO <br />(~Ueit i ej <br />E - FI nAl <br />PGrI:D l TC CCLOhA[:C }ilVf <br />_~ <br />NOTE: Rssd Ir-strvcdor» bsttxi,ctimpistir-y this form. <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br />SAMPLE <br /> <br />E OF <br /> X ANAtvsfs TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />. PERMIT F ... .. ~ n :. J ' ~ ! i :: <br /> REQUIREMENT <br /> <br /> <br />~ SAMPLE <br /> MEASUREMENT <br />.. .. <br /> PERMIT ~ i ~: .- ~ / : r• .: <br /> REQUIREMENT <br /> <br />r SAMPLE ~ - ~ <br /> MEASUREMENT <br />.. ~ PERMIT _. i ~. r ~ F i <br />:~Lk/ <br />t : '1 REQUIREMENT ~, ^ C ` ;` + ~: <br />11, - <br />r SAMPLE <br /> MEASUREMENT <br />.~ <br /> PERMIT r• ., ~ ~ ~ ,' ~ v 2. C <br />C / ' <br />r ,: ~ <br /> REQUIREMENT _ <br />. <br /> . <br />( ;v~: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. n~~ ... :tti'~' i <br /> REQUIREMENT <br /> <br /> <br />r ~~ ~ ~ SAMPLE <br /> <br />_ . <br />, _ MEASUREMENT <br />L PERMIT - i <br />~4 _ ., . <br /> <br />• ~ ~ ! ..:. 't ? ._ r. <br />. J ; REQUIREMENT ~ C R . ~ ~ <br />:i v <br />• <br />a . ,. SAMPLE <br />, <br /> MEASUREMENT <br /> <br />PERMIT ,., '. r iYY:~LF. <br />REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER ' "^"~ " ` P'""' " tew thel thM d.rvment end .n al.cn1nenV .ere TELEPHONE DATE <br />prep.red under mf dlrertlon or .uper.Mon In or[ordenn with . ffftem dd~ned <br />to rmure that queHfled personnel Properf7 pUer •nd e•.lu.te the Informetbn <br />' tobmllted. 6aeed on m7 Irpulry of Ue prrson a persau .ho mene~e the .fstem, <br />or those penoro dlnectlT re-+porNt•k for [.Inert n[ Ue Infonrutlon, the Infonrrtlon <br />submlt!td le. Io the MI or m• knowkE~e end DeMrf. true, excv rslr, end rnmpkle. ~ - <br />- 1 em .w.r. tnet Urre en *r[ninrent pe".Ina ror s"nmltnn[ r.Ne Inrorn+etlon <br />610NATVRE OF IRIMCIPAI EXECIlTT/E <br />TYPED ~ PR~~p . <br />t~+wl.[ ins po.dbult. or n"e .,,d Impn•~"",rat ror -M..I~[ .Id.uorn OFFICER OR AUTHORIZED AGENT NuME+ER YEAR MO DAY <br /> CODE <br />COMMENTS AND EXPLANA 1lon yr nrv T vlvl_n I Ivna fifsrsrsncs N/ srrscnmmrs nsrs/ <br />- - _ . <br />EPA Form 3320-1 (Rev. 3!'991 Previous edtbons maybe used This is a •l-part form. PAGE OF <br />