Laserfiche WebLink
PERMITTEE NAME/ADDRESS rlndudt forilih• \amr~l..rurn:rt it Utflnrnr <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />ii. <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 />OMB No. 2040-0004 <br />~~ <br />t~ <br />iiC. i ~~~ <br />NOTE: Read Instructions be <br />completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT 7 I ~J ~ 1 ~O LQ-r1' R <br /> PERMIT 1r _•. '1 _ _ -..'t : : _ - <br /> REQUIREMENT i•: ;;~•hf^"' ;~,;'+"t`- ~~` . <br /> SAMPLE I' <br />C <br />~ <br />I / <br />' <br /> MEASUREMENT I <br />' ~ =~ <br /> PERMIT +~ - <br /> REQUIREMENT <br /> SAMPLE / <br /> <br />MEASUREMENT _ <br />~ <br />'- ~• <br />I C~~ <br />~-~ ~ ~`~ <br /> PERMIT - ~ - ~ r: r-e I_ .. <br /> REQUIREMENT <br /> SAMPLE <br />r ! <br />~ <br /> MEASUREMENT ~ <br />! '~- ~ ~J C~~-~ <br /> PERMIT - ~e ,. -i - _ . _ .. <br />H,a' <br /> REQUIREMENT ~~ i' ~' ~'- <br /> SAMPLE '^ ~~,( <br />' <br />' I <br />~ <br />~'~'~ <br /> MEASUREMENT L. I ~~: <br /> PERMIT ~ ~.,. •-,e.:, .. ;. , . _ - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT l ~':' ~ r I ~~ ~ ~ -`~.~ <br /> PERMIT -' ~•~'- [: ,~,; r. .. <br /> REQUIREMENT <br />o- - <br /> SAMPLE <br />~ <br />~ <br />~ <br />/ <br />~ A~ <br />~ <br /> MEASUREMENT I <br />7 ' ~ IL . <br /> PERMIT ,f -. , . _ <br /> REQUIREMENT "~' '"` <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrtth under penally of law that thi, d,wumrnt nnA all uuachmen~ were <br />i <br />i <br />i <br />h <br />i <br />d <br />t <br />i <br />d <br />i <br />d <br />d <br />N ~ <br />~ <br />- TELEPHONE DATE <br /> on or <uprr, <br />n accor <br />ance w <br />a ,r,tem <br />ytte <br />preparr <br />um <br />rr m~ <br />nct <br />• <br />nn <br />t <br />e, j <br />.:~, <br />~• <br />=_,~~' C ~• p ~ `,G-~-f ' ~ <br />~ c/ <br />'~ In t~caurc Ihal yuulified prrumm•I properly leather and r~alwte the information <br />or thr <br />w•rso <br />b <br />iu <br />d <br />N <br />cA <br />~ in <br />i <br />r <br />m <br />wbn <br />a <br />e iM• <br />~ <br />te _ _ _ __ ! ~ <br />'~~l'- <br />~ c <br />. <br />on tn <br />yu <br />n <br />p <br />r., <br />ur i <br />n. <br />m <br />nag <br />y <br />s <br />m, <br />w <br />m <br />a. <br /> <br />! or lh:~se prr,uns diretlll rr,pon..iMr for ttotheritK,+ Ibe information, the information <br />~ /' <br />~ <br />` ~ `' ~ ~ whmiUrd i,, to the hat of mr knowlydKr and belie(. inx, m~ruratr, uml rompMtr. <br />t ih <br />t <br />lti <br />h <br />i <br />i <br />I <br />th <br />i <br />if <br />- <br />f <br />iui <br />f <br />l <br />( <br />SIGNATURE OF PRINCIPAL EXECUTIVE : ~ ~ ~, ~~ J.~f3 (_ ; ~ (/' ~ ry- <br />- - - <br /> ~n <br />q <br />n <br />ormw <br />nn. <br />am aware <br />a <br />erl7~rr s <br />an <br />prnu <br />e, <br />ur ,u <br />m <br />t~ <br />u <br />a <br />i <br />- <br />4 OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR M <br />TYPED OR PRINTED im <br />lading me po..ihi <br />t. of fine and imprisonment (or knowing .iolnt <br />ons. O DAY <br />CODE <br />COMMENTS AND EXPLANATION OF ANT VIVLAIIUNS (r(ererence an arracnmenrs Here/ <br />EPA Form 3320-t (Rev. 3/99) Previous edition <br />Tlllti is 3 •~-P~ f[1f1I1. PAGE OF <br />