Laserfiche WebLink
PERMITTEE NAMEIADDRESS /lnrludr Fariliro .`'nmdlirratiun ijUijjerenJl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />NAME - DISCHARGE MONITORING REPORT (DMRJ <br />ADDRESS -~ -•' i'' <br />'vJt=S i- MA 1 N ST h F ~ . PERMIT NUMBER DISCHARGE NUMBER <br />I,'+=, <br />FACILITY •-NC ITO Cr1N'~(QN M 1 iJt MONITORING PERIOD <br />LOCATION ~ t~n~ C ~~ ~:; , YEAR MO DAY Y AR MO DAY <br />FROM TO <br />tK n1~D7NG"iON, s"INE MANAC~~ <br />Form Approved. <br />OMB No. 2040-0004 <br />C7 IJNi~f~IL "fR I B OF PURE ATOR I E R <br />- .x <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 /> <br />PERMIT <br />- • - • _" r ~_ •_ <br /> REQUIREMENT f^' id ~'i , • i i=i',;r:. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~~ - ~ <br /> <br />REQUIREMENT _ <br />-' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ ~ .... - ,.. • ~~. - <br /> REQUIREMENT - ~ -' (- <br /> SAMPLE ~~ ~' ~-_ ' <br /> MEASUREMENT ~1 <br /> -... . '~ <br /> PERMIT <br />REQUIREMENT ~ <br />i - <br />~ I" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,; :. ..... __ :. <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT <br />'~ i ':`i%~:' _ ., <br />ijr:-' • <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ .... _ .. . ., .... •... -.. ,- - _ .- <br /> REQUIREMENT -- - - • <br />NAME/TITLE PRINCIPAL EXECUTIV OFFICER I certif. under p•nairy of law (hat thl<dn[Unll'OI and all uuachmems were <br />l <br />h <br />i <br />d <br />i <br />d <br />' ~ ,-, TELEPHONE DATE <br /> np diratiun ur wprrvision in mrun <br />nnn wit <br />a st+ <br />rm <br />es <br />gne <br />pn•p:rtrd umlu <br />p <br />fri, _~1 (fl ~.• ~ <br />/r ~ v <br />-y ' ' - br a+wrr that ytwliR<d prn.mnd prutxrl~ gather and evaluate the Inrnrmntiun <br />whmnhd. Fla+cd un m) inyuin ~d the person ur person. who manage the s)aem. <br />or those pt•non+dirtt4h n•+pm+ihle fur Fathering the information. the intormatimt l i <br />~ / - ~ <br />v ~1~ <br />r •~~• <br /> <br /> <br />~~ ~ <br />. ~ :~ ~ ~/'~, <br /> <br /> <br />~ <br /> <br />/f <br /> <br />/ <br />- <br />r In the M.t of m< kunwlydge anal la•lief <br />true <br />aceuratr <br />amt eompletr. <br />hmilted i< ~ V / <br />I '"~• ~ , <br />, <br />. <br />. <br />w <br />ti <br />f <br />h <br />i <br />f <br />l <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 1 am swam that Ilxre arc .ignifwront prmdtie+ <br />or w <br />miu <br />ng <br />a <br />+r <br />n <br />orma <br />on. <br />includin ~ the ibilih ..f fine and im rn. nment for knuwin i lations. <br />* p^+ P r g OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />GUMMtIV I J AIVV tAPLr~t`1M t wtv yr r~tv r vwt_n t wt~o Incrcrmwc an auaw nr.m rw rvcr c/ <br />l - <br />Thrs is A =3-pert forts. PAGE ~OF <br />