Laserfiche WebLink
Form P.ppr,:ed <br />PERMITTEE NAME/AOORESS(lwe>V4FMYryN~Lerrl•wl/DlQfwwetJ NATION Ai POLLUTANT OISCHAROE FIIMINATION SYSTEM INPOES) <br />DISCHARGE MONITORING REPORT (OMRI FMB t!c 2~4;+•o000 <br />NAME <br />ADDRESS PJU. :j Q <br />.. ~Z ~} 2000 <br />IAN _~~ r: <br />~ <br />~~}, ~ -; - .., , PERMIT NUMBER ascHAROE NUMEEN -~ F <br />' <br />- OII ~'~ `,~g~lamaUOn, .`l, - <br />'~~i 1 H Jlvj$1 <br />and Safety <br />i MONITORING PERIOD <br />FACILITY ~~ ~t ng <br />; - Min YEAR MO DAY YEAR MO DAY <br />LOCATION Z~~T FROM TO <br />~; >= R ~ ,:. F- . ("• h i-'-, i i l ~ i : NOTE: Read IMwcNorn b~lw~ compl~tlnp thl• form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, iREOUENCV <br />of SAMPLE <br /> EX TYPE <br /> µ~y~g <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT z'; • ~ x , <br /> REQUIREMENT i~tii(IMUM <br /> SAMe''LE <br /> MEASUREMENT <br /> ~- s;" a ~; 3:. :: r- . <br /> PERMIT ~~ 1. <br /> REQUIREMENT r T'7 ii C•;;JI'i i i <br /> <br />" SAMPLE <br /> MEASUREMENT <br />' PERMIT if ?~ t: 4 a:.. ,~ i> ~= :: ... # :~ , !-= :. <br /> REOUIREMENT A ~'+`'' "~- ' <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT ;%Ti; ~= F: 'I is ~ # :-; ###.:. .~ .~- '~ `~; <br /> REQUIREMENT j ~ `( hi',; <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> = • <br />R - <br /> PERMIT - _ . ~ . ~ _v- . <br />i._t <br /> REQUIREMENT _ ;=:.' , ;~?i 11_..i' P::+~ <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> <br />PERMIT 3 ~; .~ 1. <br />' ~- t. .,.. sr ~..:- :: ~: <br /> REQUIREMENT +`!A Y <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPALEXECUTNEOFFICER '"^'Ir" `p'""r°'•"th,tthBenn,n,em.ne .n.u.chnents.ere TELEPHONE <br />prepared •Mer ,n. direction or wprrMeton I" sccord,nce ,e11h , s7stetn dW~"ed DATE <br />t° •mre th•1 qu•MM1ed personnel PropeH7 L,ther •rd e.,lu,1e the Interm,tbn <br />t <br />r <br />I <br />t <br />rr o <br />Ure prison a person rho m•n,~e <br />M ,rs <br />em, <br />submitted. tined en ny Inqu <br />- - , <br />or Ihose persorn dlrrctl~ rnporr~blr fer pthert~ the inrorm•tlon, the Inrorrrrtlon - <br />~ ~ ~ <br />submitted b, b the best ar m~ lnon4d~e ,nd beMer, true. •ccunte, and compkte. - <br />~ <br />10 <br />T <br />RE OF -RINCIPAL EXEClJT1VE <br /> 1 ^m ^rr,re U•t there ,re sl~NfkiM pen,itln for wrbmlltln~ f,tse Inrorut•pon, f <br />NA <br />V A A <br />TYPED ~ PRINTED Inrludint the posdbll+ty or nne and imprf•onrnenl ror tno"Ind .1ol.tlaes OfFN:ER OR AUTHORIZED AOE1R CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IR~f~r~nc~ dl' •tt~chm~nts htrr~l <br />~F`>`r' TP ~t.'E^~T -- ~~TT!_rA>~L F 501_ II)S ' I!''IIT.='i WAIIIFL~ FOR >10YR, <br />Previous editions ma be used. This IS 8 $-pert form. PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) y <br />