Laserfiche WebLink
PERMITTEE NAMElADDRESS r/nclude Furilin .~'amr/rocwti,m i/ UiO~rrnr, <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />~.O iG4a <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> <br />I'I I <br />(S <br />NOTE: Read Instructions before 6ompleting 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 N ~A f~l`~~' ~= <br /> PERMIT `.. - ~... :~ .k := :: - _ - <br /> REQUIREMENT ; `izg,:~`'i:"' "- <br /> SAMPLE <br /> MEASUREMENT -a / ~• ~.!(., I : ~ _ . X11 ,+L <br /> PERMIT ~ 'L _ - <br /> REOUIREMENT •' '~~,~'; <br /> SAMPLE <br /> MEASUREMENT h;I 1 A Cj 1,~~ ' ,t- '~,- ~ -` -~- <br /> PERMIT Ya -- <br /> REQUIREMENT - <br /> SAMPLE ~ <br /> <br />MEASUREMENT <br />r~~n <br />-•1~ <br />I^;f`_~- ' _ <br />'~•- `-'~ <br /> PERMIT _, ~, <br /> REQUIREMENT - <br /> SAMPLE t <br /> MEASUREMENT r 7 ~[ I " ~: 1 ~ ~t <br /> PERMIT ~ . - ~ :. ~ t ,.w_ ~ .. - <br /> REQUIREMENT - ' <br /> SAMPLE ~ <br /> MEASUREMENT r~i (\j _ <br />I ~ I C ;-1 l~ . ~~ <br /> PERMIT ~ -L_. r :- ,~~~: :as: - <br /> REQUIREMENT <br />,.,~ <br />` • ~• ` - <br />,; <br /> SAMPLE <br /> MEASUREMENT n~ ,~ UI~< I '~ Q V <br /> PERMIT <br />• <br />~.:' :. ~ .:. _, - <br />-. ~ .: ••'- _; ~- <br />,. <br /> REQUIREMENT - ' <br />NAMElfITIE PRINCIPAL EXECUTIVE OFFICER I certify under pewter nrlnw Ihut thi. d.reumcnt and ull utmchment+wrre ( <br />~ TELEPHONE DATE <br /> prepurrJ under nn dircrti.m or wpenisbn in wcrorcfumr with u +~+trm de+ipud ~-~ <br />~ <br />. ' <br />- --~ 1, 1 -~ "~ <br />%e~ ~} ' ~• <br />l ~ <br />r S ~ V--`- <br />~ In a~curr thut ytwlifirA prrv~nnrl pn.prrh~ Kather and e+uluua• tM• Informati,wi <br />ed n <br />uin of the <br />•rum ..r <br />erwm+ who mrnn <br />e the + <br />.tem <br />iu <br />Ra <br />I <br />h <br />d I <br />~ ~~_` <br />. <br />- <br />, <br />. p <br />~ <br />. <br />+u <br />m <br />. <br />. <br />n my <br />ny <br />lu <br />~ <br />e <br />I or lho.e Ixrcon+directly re+pfm+iblr for gathrnn¢ thr information. the informatioa <br />~- owlyd <br />d hh <br />f <br />trur <br />nicuratr <br />and rnm <br />lcte <br />h <br />it <br />to th <br />M• <br />t <br />f m+ k <br />d h - !~~ - <br />`~ ' <br />~ ~ ~ <br />r ~ f <br />\ _ _ - <br />' ~" • <br />p <br />. <br />m <br />e <br />+ <br />o <br />n <br />t;e mt <br />e <br />. <br />, <br />w <br />t <br />, SIGNATURE OF PRINCIPAL EXECUTIVE , <br />.. ~ t - <br /> I um uwure thin thrre uR aRnifienm pmuhirs for+ubmuunti false mG•rmaunn• <br />f <br />i <br />ti <br />m <br />d <br />i <br />k <br />Nd OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED sunmem <br />nr <br />naw <br />u <br />. <br />indudln>; the prnsihilih of fine an <br />impr <br />ny ~ <br />u CODE <br />COMMENTS AND EXPLANATION OF ANY vwLA I lures (nererence an arracnmenrs nere~ <br />..--/ <br />EPA FC:rrr X32_-1 Ft: q- ~- .-... -- _ - NA<;F OF <br />