Laserfiche WebLink
PERMITTEE NAMEtADDRESS dncfwte F~rtilitp,Vame2rxarinn ijDijJenvrU <br />NAME <br />ADDRESS . C3 ('i i'1 <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCRARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form APProved. <br />OMB No. 2(340-0004 <br />{.~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />• ~ ,• SAMPLE <br /> MEASUREMENT <br /> PERMIT .. :• x ,. ,- ., ~ x.. ,. ,. , <br />-- ;; ~; ~ • • , ~ REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I n`nify under Innaln of taw that the: dxunxne and au atuchmenn tecrc TELEPHONE DATE <br /> prcparcd under my duecnon nr +uper, rsion m acr,rdsncc a tW a <~ stem Acsigncd <br />'"~- <br />ate l <br />S <br />~ <br />~ <br />~ <br />9 ro assure that yuahticd perwrtncl properly gather and ecaluam the mtixmanon - <br />a <br />- <br />" <br />~~ <br />J'~. <br />~' vbmmcd Eiascd un my myuiry of the person or pcrsc~ns u•ho manage tttc system. -- ~ ~ <br />-z <br /> or those persons directly resportsihle for gathering the mti~rmauan. the mkrrnranon - - <br /> aceurntc <br />and com <br />lere <br />th <br />t <br />9 <br />d <br />and beli <br />f <br />trv <br />b <br />itt <br />d <br />t <br />b <br />f <br />A - <br />' " ~' <br />L . <br />now <br />ge <br />e <br />. <br />r. <br />p <br />:ru <br />e <br />ts, <br />o <br />e <br />es <br />o <br />my <br />e <br />m <br />:d <br />d <br />h <br />h <br />l <br />f <br />b SIGNATURE OF PRINCIPAL EXECUTIVE i ;, ~ "F. <br />,v <br />_ • <br /> ancu'nr: <br />ties <br />or su <br />mnung t <br />,r on <br />I am aware t <br />at t <br />ere are significant pena <br />f <br />k OFFICER OR AUTHORIZED AGENT AREA <br />~ NUMBER~ <br />YEAR MO DAY <br />TYPED R PRINTED or <br />rnncui_ ~ i,~l,ru„u> <br />mcludmg the pixsihihty of tine and unpnsonment CODE <br />COMMENTS AND EXPLANATION OF ANY VIVLAI IVNS (Hererence an arracnmenrs nere~ <br />q.} <br />EPA Form 3320-1 IRev. 3!99) Previous editions ma be used. ,r}-' ~fi5 IS S ~- ~t'L 1o1'til. PAGE OF <br />Y ~.t~%C,., _ P <br />