Laserfiche WebLink
PERMITTEE NAMEIADDRESS ~ht~iud~ F~trilin ~~~~~,~ ; • ~ .,.~,, ~ hirr, ~,,r <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />~.. C' 814 c e <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <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 />MI <br />(~ <br />Form Approved. <br />OMB Np. 2p40-0004 <br />f1W -i:, UN°;~f TRiA,'HiJBIiA~{II GREf= <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 />,-,,~.:. <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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ rertiF under pcnatR of law that thi. dtwumem and ull atwrhmenty were <br />e with <br />srN <br />m drvr <br />ned <br />•d u <br />d <br />dir <br />ction <br />s <br />i <br />i <br />in a <br />trd <br />m <br />• TELEPHONE DATE <br /> g <br />pn <br />pan <br />n <br />er m} <br />e <br />ur <br />uptn <br />v <br />un <br />cr. <br />t <br />r <br />a <br />e <br /> to :nsurc that yuallfied perconnrl prnperl~ gatlnr and evaluate lfte infonnatFnt <br /> vuhmitted. [Saved nn ms inquire of the pcnon or per.onv wloi matutge the yvttm. <br /> or thov~ fn•nons dlrca'tly nynmvibh• lur Calhrr{ng the Inforrtuuitm. the infnrmali/m -' <br /> vubmignl iv, to the fn•st ..f m~ knuwlydge and belirL tnx•. w•a~uratr. rend complete. <br />w <br />fur v <br />h <br />infnrm <br />tion <br />I <br />r <br />that Ih <br />r <br />r <br />.i <br />n~ <br />t <br />r <br />lli <br />ilti <br />f <br />ls <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br />- <br />TYPED OR PRINTED am a <br />r <br />e u <br />r <br />g <br />e~tn <br />p <br />na <br />a <br />u <br />m <br />ng <br />a <br />e <br />n <br />. <br />a <br />e <br />irn~hding the p.nsibilit~ .d fine and impr'rwnmem for knowing violations. OFFICER Ofl AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />EPA Form 3320-1 (Rev. 399) Previous editioru may be used >~:)4~ ~ This is a 4part form. <br />