Laserfiche WebLink
PERMITTEE NAMElADDRESS(/~~,fevbryN../1er.nonr/D~...~f) <br />NAME <br />ADDRESS <br />,'32 57A~` HIGHWAY !--, <br />FACILITY ~vsrC1;~JYC~ -,rn=: <br />LocAnoN r'~ECESt~.F? r~ 7LL t ~1~-~_.c- CS2 ~4I <br />''~'r~_'1.-i ~' L- ~i~ry 1..1=f\Jf Yf S~ 5J~ l~f v <br />NATIONAL pOILUTANT a5CNM0E ELIMINATION SY4TEM //NPOESJ FOtm ApptOW!d <br />DISCHARGE MONITORING REPORT /OMR/ ; ; !;j[j4' OM8 No 2040-0004 <br />PERMIT NUMBER ascNMOE NuMeEn `" - ; i'~ ' E'~ i I`i 1~i1-' <br />f?EE~fER ti-Ui.".CH ; 7 vOEi~= ~F'v5 ~_ <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY. __ <br />FROM TO '_: ~ ~,"~ .. <br />NOTE: q~11Q IrnttucNorw bdor~ t:omphtk-o thh form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. rclECUENCr SAMPLE <br /> of <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALrsls TYPE <br /> SAMPLE ~ - _ <br /> MEASUREMENT ~ ~~ • <br /> <br />' _ PERMIT - - . -. ,r <br />. • ..~ REQUIREMENT _ .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <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 /> REQUIREMEN~' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ---- ~ -- <br /> REQUIREMENT <br />NAME/TTTLE PRINCIPAL EXECUTIVE OFFICER ' Ce^" I " " w""f " '•"'h"'^'' dOCO1Ar"' .na •° •lt.rnmenff .ere TELEPHONE <br /> <br /> <br />~ <br />prrp•rrd under tw) direrlbn a fuprr.hion In •ccord•ncr rllh • f)fleln dcd~nM <br />,;i ., DATE <br /> <br />fl/ r ~ f f ~~. , to -feturt IhM qu•Mned perfonnel properlf ~•Iher •M er•hl•le the Infnrnylbn <br />' <br />% ~ ~ ~ <br />' <br />~ <br />' ~ <br /> .Demure. effud on mf Inqulr) of ufe person or perfom who m.n•Re the trnem, • <br />. <br />i , /1 <br />. <br />, <br />1 <br />r <br /> <br />. <br />" <br />~ ~ or thou pennfu dlrecllf refpoMbk for ~•IhMn~ lM Infornullon, the Infornrlbn <br />b <br />f l ~ ! 'V~ <br />'te`'" _ y-~ <br />~ <br />1 <br />` <br />` <br />~ <br />~ ~ <br />_ <br />_ <br />r w <br />tNlled h, b fhe bel o <br />mf knewkd~e .nd beYrf, Irve, •tevnle. and fomphYe. <br />1 .m ..^re Ih., thert.re fliNnunl pen,ltltf r"r.uhnrln <br />f.t <br />r Inr ifONAT <br />F -AINC <br />R /[. <br />,+- <br />f - ~ i ?C l'~ <br />~ ~ ~ <br /> <br />TYPED OR PRINTED n~ <br />. <br />".,n.llon, <br />Inr+Deln~ IM poffdhlllt~ of flee •M Impr1•onrnenl for Lno~ln:.lel•tlonf. LI <br />E O <br />I-AL EXECUTIVE <br />OFFN;EII OR AUTHORIZED AGENT <br />E NUMEIER <br />C <br />YEAR <br />MO DAY <br /> OD <br />.......... .. ~ r.~.f, ".....,~.., ~.,,..... ..... ..__.....,.... ,,..._,........, ..._....,,...,.~ ,...., <br />q PF2ECIP i=V'. <br />IF CLAItrt A??RQ~i';D I3'T'~ W <br />EPA Form 3320.1 (Rev 3199) Previous edfions may be used T~113 tS a a-p8ri f~rnt. PAGE OF <br />