Laserfiche WebLink
PERMITTEE NAME/ADDRESS (Include FarrWv :Vance/Lncarian i/lHjj~rerul NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />NAME _ - - <br />ADDRESS :.~~i": - ~i~iV 1`1 <br />BOn ~ ac8 PERMIT NUMBER DISCHARGE NUMBER <br />~A MONITORING PERIOD <br />FACILITY ~~~ I ~{]j~ ~} I ~.~~ YEAR MO DAY YEAR MO DAY <br />LOCATION _A FROM TO <br />Forth Approved. <br />OMB No. 2040-0004 <br />Ri<~t~IfvE Df~iVB TRi6 TC GALP.t-i1TY <br />NOTE: Read Instructions before completing this form. <br /> NO UF NCY <br />FREO SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />. <br />EX <br />O <br />ANALYSIS <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />T i ` ~ _ <br />t ,-; ~, 6it~ , <br />MEASUREMEN • ,a <br />~ <br />- <br />~ ' ;,.; <br />. ,...~ n PERMIT .~ r,' ;< ~ 1=t <br />~., <br />~tt0~' aVS= `- <br /> REQUIREMENT I <br /> SAMPLE <br />~ <br />~ , <br />~ <br /> EMENT) <br />A <br />j _) <br /> ME <br />SUR Li <br />r <br /> PERMIT ;;..;(. ~ n• ~ R E .: . c: <br /> REQUIREMENT <br /> <br />SAMPLE ~ <br />T <br /> <br />~ <br /> <br />/) • /~~ ~ h <br /> MEASUREMEN <br />G ~ - <br /> <br />PERMIT ~ 7Y ~ NSF x -. 't ~ ~ ~ <br /> <br />''!}r~ .. <br />. , -- <br />``~~ <br /> REQUIREMENT <br /> SAMPLE r <br /> NT <br />R _ <br /> MEASU <br />EME ~' <br /> PERMIT <br />" :. ~ - ~ <br />_:~ ~^'~'~= <br />~~AIL • ; i <br /> REQUIREMENT <br /> SAMPLE <br />~ <br />'r <br /> - `'~ Z <br /> MEASUREMENT ' <br />; <br /> PERMIT -. . , .. ~ <br />.,.-,, <br />,:,'' ,~ "., ~' ", <br /> REQUIREMENT . <br /> SAMPLE <br />~ <br />i-~ <br />J <br />~ <br /> T , <br /> MEASUREMEN <br />, i <br />, r_. . <br /> PERMIT _ <br />'t7DA A~'G _ <br />Y r': ;, • ~, <br />T' <br /> REQUIREMENT <br /> SAMPLE ,' ~, j ~ ~ . ~ <br /> M <br />T '~ _ <br /> EN <br />MEASURE <br />~ <br />~_r. <br />t <br />... - <br /> PERMIT -. .., <br />(;tr;. • . <br />r,•.: ' ! t 1, .i.- <br /> REQUIREMENT , <br />NAME/TfTLEPRINCIPAL EXECUTIVE OFFICER laenif>underprnsJhnrmwthNtthi.docum~ntnndall~twahmrnt+werr <br />prepared under m. dinrtiort or caper. isiou in acrordunre with u s)stma designed __~_-~_ TELEPHONE DATE <br /> <br />t.. us+ure thw yurliRad pcrv~nnel prnperl) gather and e. aluate the infnrmaliun ` <br />,~ <br />-- <br />.uhmined. Rnsad on m) inyuin ~d the penam ur persona whn manugr tha• +) stem. <br />the information <br />fwma6un <br />th <br />• i <br />l <br />f <br />h <br />i <br /> <br />-'7 <br />/ <br /> . <br />er <br />ng <br />a <br />n <br />e <br />ur twt <br />ur thosa• prnum dinc0) rccponsih " <br />~ <br />i <br />~ • <br />~ <br />- In the best u( m) km.wlalgr and helu$. Irur, aaruaatr. antl aampkte. <br />b <br />itt <br />l is <br />URE OF PRINCIPAL EXECUTIVE - <br />~ <br />~ . <br />su <br />m <br />a <br />ti <br />i <br />f SIGNAT <br />' <br />~ on. <br />orma <br />n <br />I am aware that there an significam penalties for submitting false OFFICER OR AUTHORIZED AGENT ARE E NUMBER YEAR MO DAY <br />TYPED OR PRINTEb including the parsibilil) of lure and imprisonment for knowing +idatiom. <br />COMMENTS AND EXPLANATIVrv Ur arvY VIVLH 11v14A Incrcr craw an oaao+.a,...~ <br />L F~ . - <br />0003:= °-This.is-a 4-pdrr'farm. <br />