Laserfiche WebLink
PERMII'TEE NAME/ADDRESS Ilndade Farility :\'amdLkaOnn if DifferenN <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />I.) g l ~~v <br />An~~ <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 Approved. <br />OMB No. 2040.0004 <br />~ SL+Liii it?1i ; <br />F - F Ii+i/4L DEI <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX Y <br />I TYPE <br /> ANAL <br />S <br />S <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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT <br /> <br /> SAMPLE , <br /> MEASUREMENT ~' ~ 1 ~i'%~ •;' ; <br /> PERMIT - _ i- -, r.: , -,- <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , ._:'~~R ~. <br /> REQUIREMENT •- ~ ~ •' -- <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ~erufj umkr penaltc nr mcc thin this d,rmnanl antl all attachmann Marc TELEPHONE DATE <br /> prepared under m~ dirrdicm ur cupen ieinn in acenrduacr kith a yctrm designed <br /> b, escort thW yualifted parconnrl prnperl~ gather and evahwtr tlK information <br /> cuhmitted. Rax•d nn my inyuin of the prrccm ur prrsanc who manage thr +ysiem. <br /> or thc,sa prrccmc dinrtlc raspnnsiMc fnr gathering the infnrmatic,n. the informatiwn <br /> cuhmiUcd i>. to Iha beet of m. Anossledge anJ twlic/, trw•. acc~uratr, and a,mplatr. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aaarr that thc•rr err significant penaUiec fnr whmittlng false infnrnwtinn. AREA <br />TYPED OR PRINTED including thr pncihilit~ of fine and imprwmmcm for wm,aing sio7atiooc. OFFICER OR AUTHORIZED AGENT OD NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />I T a s Lc~~.I E s'r F I~R <br />EPA Forr~~ :?:S~t'~ ~ ~. _. _ , . us ad~CCnz rca. t~ .-, , <br />~oc~a ; ~rn~s is $ ~-Parl rorn-. <br />