Laserfiche WebLink
PERMITTEE NAME/ADDRESS lfnrfudc Frxilitr .\'amrMcdtion if (hJJerent <br />NAME <br />ADDRESS <br />FACILITY I, ~• !` •:? i F ~: T `e 1•:L ~ T !"~ i i'I <br />LOCATION i S A ~ ' ' ° <br />•., <br />NATIONAL POLLUTANT DISCHARGE ELIMINAT70N 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 />Form Approved. <br />oMS No. 2oao-oooa <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 />Y• ~ ~'' <br /> SAMPLE ~ <br /> MEASUREMENT ~ -~ •:' <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERM <br />T ..: ..., <br /> I <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I aa•rtit> under pa•nall~ of law lhnl thi. d+xnmrnt and ntl etmchmrnh were <br />d <br />ti <br />i <br />ith <br />l <br />di <br />i <br />i <br />d <br />t <br />d <br />i <br />d TELEPHONE DATE <br />__ <br />~ <br />i <br />'- preparrt <br />er m~ <br />rec <br />on or wpen <br />on <br />n accor <br />ance w <br />a sys <br />em <br />gnr <br />un <br />± <br />es <br />ualificd <br />on <br />lin <br />r <br />that <br />e <br />l <br />rn <br />rrl <br />athr <br />a <br />d <br />lun4• th <br />inl <br />r <br />~ <br />p na ~ <br />~ n. asw <br />r <br />y <br />ne <br />p <br />t g <br />r <br />n <br />ew <br />r <br />u <br />ma <br />n <br />p <br />rs <br />p / <br /> <br />/ f-. .uhmiuad. Rased on ms inquire of the prrsam nr prruros who manage the satem, <br />nr th+nr prnam dirrcth rrsponsihlr for gathering thr information, the infornation ~ ~-1 ,'. <br />'( ~ • •- / E' - .,^I <br />~i r - <br /> <br />i ~~,, <br /> <br />• <br />', J r - ~ <br />VVV suhmittrd is, to the !K•ct of m~ Annwkdgc and hcli<`L trur, acYUratc. and atmpktn <br />h <br />i $tGNATURE OF PRINCIPAL EXECUTIVE / + <br />- <br />Y <br />O <br />D 1 am aware that t <br />ere ore siQnifwvnt penaltirs for whmiUirtg later informat <br />on, <br />din <br />thr <br />ossihilits rafine and im <br />risonment for km+winl <br />sidati+ms <br />i <br />i <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />PED <br />R PRINTE <br />T p <br />p <br />, <br />m <br />u <br />g <br />< ODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />PAGE OF <br />EPA Form 3320-t (Rev. 3199) Previous editions may be used. rhlti Iti a -1-earl IOCnI. <br />