Laserfiche WebLink
PERMITTEE NAME/ADDRESS Ilncladr F'acilir}• .~amdlorarinn if 1)if/rrcnr <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <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 />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 N ~ ~~ -~1 G Dl f ~ ' ~~ ~- t --E- <br /> .. .. _, - <br /> PERMIT <br /> REQUIREMENT ~ •! ''' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT + <br /> REQUIREMENT <br /> SAMPLE , _ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> <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 .<rtif~ umkr prnult~ of 1nw mm utis d~K~umrnt and au uuachmrnt+w<re <br />d <br />i <br />i <br />i <br />h <br />d <br />i -- ~ TELEPHONE DATE <br />_ <br />1 ~ I (\ ;~ _ ~ r ~ <br />~ <br />l J ~m in uce~~rdnnce w <br />prapetrtt ender m~ d <br />rection w +up.•r. i. <br />t <br />a .ys(em <br />e+ <br />pm <br />lu q+wrr Ihut yualiRad pennnncl prnprrl~ ~n(her and waluule the information --- - - ^_ <br />~ <br />L <br />~ <br />J ~ +ubmiued. Buw•d nn m~ im(uirr of the prnon nr per~m~ who manage Ih< s~+trm. <br /> <br />or th~w4• prnun+dirail. n+lwusibk for gathrrinL the information, the infurrtutinn - - <br />/ ~ ~_ 1 1 <br />'? 7 C • <br />~ <br />t kmtwkdge and belief <br />true <br />cecurntr <br />and eomp(rta <br />.ubmitad i+ <br />w the k+t of n i <br />~ lrs ~ -~ C~ ~ I ~, <br />` , , <br />, <br />, <br />q <br />. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I nm uwun• Ihat then are pignificun( Ixnul(Ir+ far +uhmil(ing false in(ormu(iun. <br />AREA <br />TYPED OR PRINTED inehulin¢ (h<pas+ibilit~ of finrond impriwnmrnt for km~wing+ioiution+• OFFICER OR AUTHORIZED AGENT NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIQLATIONS (Reference 'all attachments here) +; <br />__ ~~~SIJt .,~ (?iv "fHTr+ C?U7FALL l `~ M1lr!T. <br />r -.. <br />PAGE OF <br />-~a c;, ,- ~:_~. I ?;. - -i'hi, i. a ;-Harr I~~nn <br />~. - <br />