Laserfiche WebLink
PERMITTEE NAMEiADDRESS .blrludr!'ucl/try• Nume.'l.r,rurion ~/DI~/ivin0 <br />NAME <br />'r <br />ADDRESS _ '1 1 i 1 ~: <br />` ;'t.LY ::O c~ 1 =413 <br />FACILITY ~ ~, _,L~ r.- I n;; . <br />LOCATION ~ y- .-, ~ ; ~; ; t, 4` <br />NATIONAL POLLUTANT DISCHARGE 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 />pMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. I FREQUENCY <br />OF SAMPLE <br /> ~ TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />- ~ SAMPLE ~ _- <br />.-. ~; L : MEASUREMENT C' CJ ~ < G~ D~ ~ ~ - ' ~< (~• l• <br />.. PERMIT -:l- ' L ~ 1-, .. 'y' r, ; \ r- <br />v _.' REQUIREMENT '`' ' M;` <br /> SAMPLE <br /> <br />-; : _ <br />MEASUREMENT <br />~'.OL _ <br />`~ <br />~'~ <br />~ <br />_ <br /> PERMIT - ;`E-; ,. <br /> REQUIREMENT - ' '~ <br /> SAMPLE <br />- _ ~ 7 MEASUREMENT ~ ~.-• l ~ U , OO I ~• . <br /> PERMIT , RFPCR ' <br /> REQUIREMENT ~ ~ :ir"a:l <br />r ~ <br />• SAMPLE - <br />i-{ i <br />Cam( <br />' <br />U <br />- <br />t`, ~ . _ <br />r':L MEASUREMENT . <br />, <br />. <br />.~ ~ PERMIT _ c:• F ~. ; , . -* , <br /> <br />' • ~ 1' REQUIREMENT - <br /> SAMPLE <br />- _ ~ /~. <br />- MEASUREMENT D• U v <br />? G r/ ~ - .z! ~ <br /> PERMIT .- =r"-, _. Y•.F'i?,R7 r~[f' T•..-. - ... <br />r~ ;r(j~g ~'.'a: ' !- REQUIREMENT 3:'1'JA AV ~ i.1(~ t i_ 'r' <br /> SAMPLE . _. , - / <br />- „~ E MEASUREMENT aLi U p ~ <O , ~ G / C' / <br />~ ~- <br />! <br /> PERMIT .. .. K. ..~ ~, ..-. F'~_rt-;-? i r;~Pn€~ (~ +~ <br />I ` <br />- <br /> • <br />FL-~ ts~ .; .: ~ ,':~~ - REQUIREMENT is ^• _ rvi ; <br /> SAMPLE •~ <br />// <br />1•trf Q;~_ `!: '- ~- MEASUREMENT <U,OG' ~ CU CCU I V ~ °r ~ <br /> PERMIT ~ { <br />} o-:r <br />_ <br />:,,:=F"~r'' <br />'C~'t~r'ftiii I <br />r <br />i frX:. <br />':ll <br />- REQUIREMENT ~ • - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I centfi under pctwlty of law that tht> dcwumcnt and all anachments Here TELEPHONE DATE <br /> prcparrd under my dvecunn or supeniston m accordance with a s}stem dcagne~i <br />~• : - ~ ~ <br />" <br />S W :cisarc that yushticd pcrxmncl properl} gather and evaluate the m0.,rmauun <br />°"-- <br />" <br />` <br />!G':' <br />y C % ? ,• -"i Yiihnirtttll- Rn.ud nn my inywry of the pccson ar pawns whu manage the ,vsiem, i - - ~- <br />_ <br />--~- <br />/ <br />~ <br /> or those persons directl}' responsible 1nr gathcnng the in(armation, the infontwuon ~- <br />'-"f'~"' <br />- <br />' - t <br />t <br />l <br />te <br />d i <br />f <br />k <br />l <br />l <br />d b <br />li <br />f <br />d <br />b <br />h <br />b C ~ ~'~ r <br />~ <br />~ .: L -, , <br />rue, accura <br />e, an <br />comp <br />. <br />s, to t <br />nuw <br />ge an <br />e <br />e <br />e <br />su <br />mitte <br />e <br />cw o <br />m} <br />a SIGNATURE OF PRINCIPAL EXECUTIVE •- ~ "~ I <br /> t am msare That there are s>rgnJeant penalnss fnr .ubmnttng fake m(orma[ion• <br />i <br />i <br />i <br />k <br />l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />TYPED OR PRINTED ne and imprisonment <br />nr <br />nowme rto <br />at <br />ons <br />including the pnssibtln} .+f t <br />CUMMtNI, ANU tXYLANH11Vrv yr NI`I <br />I IIC/CI C/ILC CI/ Ol[Ol.llI11p11[J IIGI CI <br />}OO0 ~ This is a -1 <br />