Laserfiche WebLink
PERMITTEE NAl1AE/ADDRE55 pndlr4 iarlMry N..a/Latutw Vp~twQ NATION AI VOIIUTANT Dl4CHM0E ELIMINATION Sv4TEM (NPDESI <br />DISCHARGE MONITORINQ REPORT IOMRI <br />NAME <br />~• . . <br />ADDRESS a : ST r'~TE , <br />PERMIT NUMBER g4CHMOE Nl1M•ER <br />MONITORING PERIOD <br />FACILITY •'il 1 ~ n '~IN~ YEAR MO OAY YEAR MO DAY. <br />LOCATION _ i:J 31641 FROM TO <br />G`LaNfil~iat . VF i it Ili • <br />Form Approved <br />OMB No. 2440.0004 <br />M- i N~ -~ R I I`1 I"I'- <br />5T17KGR COF~L ~_ ~~r+DOUTiWIL~~S]N CR <br />_ _' .. <br />NOTE: R•~d k+•ttuetla» b•f«• cornpMtinp tM• Iwm. <br /> <br /> QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. <br />~EaoENCr <br />SAMPLE <br />PARAMETER EX st4 <br />Al TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS r <br />AN <br /> SAMPLE <br /> MEASUREMENT <br /> <br />- ~ PERMIT .~ ; . ; I-~r'. ' I!'"•I.~h~ ~ .-. <br />- ~ -' REQUIREMENT <br />' SAMPLE <br />+- MEASUREMENT <br /> <br /> PERMIT ;r <br />`•.,• - .~ i j ..7~ : ~ - - <br />;- l.•'~-' •~ REQUIREMENT •l <br />' <br />- SAMPLE <br /> MEASUREMENT - <br /> <br />~ PERMIT ~;.1 ,..~. <br />_ - :~~ ~. <br />• %'--' ~ - REQUIREMENT <br /> SAMPLE <br />•' ~ ~- ``' ~ • MEASUREMENT - <br /> <br />` PERMIT -`- -''.' , ~= ~~ _ ' _;i f <br />- ~ , • - ,. REQUIREMENT - <br />.. ~ . . - <br />- ~ SAMPLE <br /> MEASUREMENT - <br /> <br />' PERMIT ! i•.i:~T Mfii~ - 'i-•'` ' <br />- `= -~'° REQUIREMEN"t <br />7 <br />r4 ' r:. A. <br /> _ <br /> SAMPLE <br />' "-' ~ ~ - ` ~ ~ ~' MEASUREMENT _ <br />=~- - <br />- <br />' SlJ <br /> <br />I - PERMIT • <br />;rX <br />,. <br />,; ..::, <br />~ <br />~' ~ REQUIREMENT - -- <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PER MIT <br />fEQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER ' "^"~ ° ° pens 1] o hw thal IhM dacvtnenl and atl all^chment! were I ~ - TELEPHONE <br />prepared undtr 1nf dlrettbn o! wPerHfon In ^ccord^nre wltA ^ ^~^tem deal~ned ~ ' <br />~ GATE <br />~~ <br />~• ~~ <br />In l1fYR Ihal r•Y.IIf1ed ptreonnei ProPerl) ~^Iher ^nd et^h1^te IM Infnrwtallon , <br />/ <br />/ <br />~~ <br />, <br />1 ~ <br />- - <br />. ~ . toDmllted. 6^sed on me IrpulrT o(the Peron or ptnoM wM wuna=e 1M r~etrm, , <br />y( , <br />.~ <br />Inforrr <br />tien ~ 1 <br />~ %'` <br />dEk f <br />lh <br />the I <br />fe <br />tl <br />th <br />' ~ <br />t <br />i <br /> <br />.. <br />~ <br />. tc+Pon <br />a p <br />er <br />rq <br />n <br />rma <br />on, <br />e <br />r <br />~ <br />w Uou penom dlrett <br />J ' . J'L - _ <br />• <br />~ r- tahmllted I^. fo tht hest of m~ YwowYd~e and Setlef, true, area rare. •nd comP4ete- ` <br />• <br />, ~ ~ <br />. <br />C <br />T <br />; <br />, <br />_ <br />~ endtb roe wrbmlaln~ bite infornutlen <br />^n d <br />niflcant <br />U <br />t the U <br />IVE <br />•IONATVRE OF PRINCI-AL EXE A A <br />- , <br />~ <br />P <br />re <br />I ^m a.aR <br />a UTHORIZED AOEPfT <br />I NUM9ER YEAR MO DAY <br />I <br />ED Inaiudfn~ thr Pondblllt~ of floe ^nd IrnpAtmtment for knowln~ .Idat{orts I OIt A <br />OFFICE CODE <br />T <br />TYPED ~ PRM <br />COMMENTS AND EXPLANATION Vt t,nT vlvtn t wn~ tntn.rtrrr~w ~• -••-~•••••~•••~ ••-•-• .4Hf <br />.., , <br />VAN) 1`.S t.Lh1!'i>=iJ. 1r ~..Lnarl rt t •....~.~ _.. _. <br />-rc; - '~'=E ? P, ~t !_' ~' i r©? I?'. ~FL'~!`d CIF F <br />•::'~~5b!•.fiAis is a 4=pan (oral PAGE bf <br />EPA Form 3320-1 {Rev 399) Ptevtous editions maybe use <br />