Laserfiche WebLink
PERMITTEE NAME.~ADDRESS ~Lr<•IrulrFrw•ilin•.h'umc7rr<•ationi(pip;arnrl <br />NAME %~"OI;E~~ira~;, LL.L <br />ADDRESS ~ - _ •_ i`1 i :`: L <br />Ltr''r AFd STAT I L:N RLtAD <br />VGTDN ti^.Y <br />FACILITY -1. h ~; ~E <br />LOCATION `JN (~~ ~ <br />:,:F ADL>INC:I•DN, t3i•!1'atR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) _ OMB No. 2040-0004 <br />:~ <br />l ~: iJ µ. . <br />PERMIT NUMBER DISCHARGE NUMBER -- FINAL LAMA: <br />~• <br />MONITORING PERIOD '}©FF PO(~IJ 5: P VREiATOI RE RIVER <br />YEAR MO DAY YEAR MO DAY `~ <br />FROM TO -- - T ~ ' <br />NOTE: Read Instructions before comnietina thlc farm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />~ OF <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE •i •f ~ , :. - <br /> MEASUREMENT <br /> PERMIT ~#~#3i-iF ,`F;tx-.t#~ =~ #:i ~#.~,-.~ st:: , <br />- `•i ".!. REQUIREMENT ~ ~ ' f"' f•1AX. i i`ivt•I <br /> SAMPLE r .: .t , <br /> MEASUREMENT <br /> PERMIT , -: it sl• , -r ii •# ~ ;- a .. , - ~ :r ~ <br />. '.`i REQUIREMENT ^''; 3G'L7fi ~ !`•;% is FS~,' µOFJ j?i <br /> SAMPLE s .r _- r , .a. s ... <br /> MEASUREMENT __ <br /> PERMIT '. t . ,4 s, - ~ # .i r .. i r <br />-- _ - ~ - REQUIREMENT ;:r~IL'r' Nl~ 'i ~'IQf~ITN <br /> SAMPLE ~ ' ' <br />' MEASUREMENT <br /> PERMIT ~-x#-o- ~ ~•~ •~ F't~ - ~ 4:. r <br />.' REQUIREMENT `}~ 30L'~~: '~A; I L ~ .. -'• h10'a }-H <br /> SAMPLE -r t '! - , <br /> MEASUREMENT <br /> PERMIT # ~F• ~a jr:a ~, ~ ~ <br />• ~r,~J~c, '•1~.:. - REQUIREMENT 'r,~ -~ if•; ~. ; .=rA r: _ GENT <br />:4Ii iJ 1 I-'' SAMPLE " ~ Y~ •a :r :r <br />I r;__r~~ ; i tEMT FLh'v' MEASUREMENT <br />r~- r' PERMIT -' - _. ..,~ ~ '~ -. r . a cif _ <br />.~ <br /> REQUIREMENT _ ,- :,VG rJkI'-- r'! _-' > , <br /> SAMPLE -.: r ~ - ... -~ -,: <br />~ <br />~'' MEASUREMENT <br /> PERMIT .. . _~ .~ _- 1 - - - - - :. -. - _ <br />. ~ ,_. ~ <br />- REQUIREMENT I N`.:; ; MF', <br />NAME!'1TLE PRINCIPAL EXECUTIVE OFF ER ~ , cndy under penalty of Iaw thin this documrnt artd all mtuchmene, were <br />prcpartti under m ~ dinruon or supeni>inn in acrnrdattee wtilt a s}stem destgnnl ~ <br /> <br />, TELEPHONE DATE <br />~ <br />'' '~' <br />' <br />' ' h <br />h <br />i <br />l , <br />~ <br />'' <br /> <br />~ (/ <br />~ ~ <br />~~// • ~,- T ~ <br />~ <br />~ to assure t <br />at ua <br />t <br />ed p ape ga <br />y peramtte <br />n rly Cher and evalmtte the mfnmwtron <br />/' ~ <br />!/ <br />~1 <br />~ ~ suhmincd Hand in my inquiry of the perxm or perconc whn manage [he syxtem, ~ / i <br />~ ~ <br />> ur those perarnis directly rcspmniblr for cathcring the mfortnahnn, the mfommtion ~ [ <br /> <br />- E'_ ~ ~`a t _ ,ubmitted:v, to dte bent of my knowledge and belief, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL E ECUTNE __ <br />i /~~ /) <br />(/ <br />/~ <br />I .un swarc that there arc ngmticant pcuahies t2:r submitting fake information. <br /> <br />TYPED OR RINTED inch~din~ the poc5tbilhy of tine and nnpnu+nment 1trt knowing violations- OFFICER OR AUTHORIZED AGENT AR A <br />NUMB R <br />YEAR <br />MO <br />DAY <br /> CODE <br />.........."............... ~.......~....., .~.., .,...._..,.......~ t..c.c.o....v o~. a.ao..nn.cnao ~~mc~ <br />• '~,: .IJL1 REPORTEI <br />ii '. .MI <br />ui ;'d ;~ ~'A}-iA '=Lr1="~T -`OFF f~ <br />EPA Form 3320-t (Rev 3i99) Previous eddrons may be used. <br />L e< G i <br />SE'F I R i D t P 9 TSS & <br />.r - <br />rn« is ~, ~•Irart tor-m ----- - Page of <br />