Laserfiche WebLink
PERMITTEE NAME/ADDRESS Nnrlnde Fxi(it_v A'ameaaration iJLtJJerentl <br />NAME <br />ADDRESS ~ ,. <br />~~ 7 (7 <br />CU SI63~~ <br />FACILITY ._,_t", I'!Lf~JE CCIN'F'!_..- ~~ <br />LOCATION : i I',f Ch 8?.63~~ <br />I~ . ~ ."t_~,t~a 1 f.l7N MAI'~~A~ER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DA YEAR MO DAY <br />FROM TO <br />Form Approvtld. <br />OMB No. 2040-0004 <br />T?5f'Ht7 Tn rRIf~i~,AGE CRkEK <br />NOTE: Read Instructions before Eompleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> gNALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT • <br /> REQUIREMENT "' ~ ' <br /> SAMPLE <br />i;; MEASUREMENT <br /> PERMIT '' F~:„ bra ~ ~. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~ ' <br /> REQUIREMENT ~ ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crni@ ,mdrr penaus nr law that mis d~xumrnt and all attachmem+ wrrr <br />9ion o <br />acco <br />r <br />d u <br />d <br />r nn di <br />r <br />ci <br />i <br />n i <br />da <br />with o . <br />ste <br />desi <br />d TELEPHONE DATE <br /> p <br />epare <br />n <br />r <br />rea <br />r +up <br />r <br />+ <br />o <br />u <br />r <br />nce <br />m <br />ttne <br />} <br /> to assure that yualifird pe rsonnei pr.,prrl~ gather and esaluate IM• informuti,xt <br /> submitted. ftawd on m~ inquiry of thr prrwm nr per.,aa~ who mawgr thr .~+tem, <br /> nr ihn+r peruuu dirrcdy respnnsiblr for gathering thr Information. the information - <br /> +uhmiurd is. to the hr+t of m. knm,ledgc and belief, true,,xmratr, and complete. <br />lli <br />1 <br />h <br />th <br />i <br />if <br />m <br />f <br />b <br />itti <br />f <br />l <br />i <br />f <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE I t <br /> <br />TYPED OR PRINTED ere art s <br />or su <br />ng <br />on. <br />am aware t <br />at <br />gn <br />ica <br />pma <br />e+ <br />m <br />a <br />se <br />n <br />orma <br />including the pymibility of fine and imprisonment for knowing siolatiams. <br />OF ICER OR AUTHORRED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />r,., ,. r•o~n~~ ~,"E , to i x Tr;F; wfrfty r rn~t rlvr - 2 f <br />EPA Form 3320-1 (Rev. 3'99) Previous editions may be used. TI14S IS a 4-aft fOfltl. PAGE OF <br />