Laserfiche WebLink
PERhi1TTEE NAMFJADDRESS t/nrludr Pat4iry A'pn,c/tocatinn rf pi,Q'nrnq NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />13 C) X ~_ PERMIT NUMBER DISCHARGE NUMBER <br />'_iF'R <br />FACIUTV `GA r1INi= ~: mil'+I MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />': i=N FROM TO <br />•f I~CAfiCJ. Ft~CI.. t _ - <br />Form Approvetl. <br />OMB No. 2 ~0-000 <br />F - F I t~IAL <br />L~F;CN~' Tf1 zR I l3 'SraGE CR1~1"K <br />~., <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <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 /> <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 />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER i errtiq under prnalq ~>rmw that thi<e«vmem:md:dl auachmenl were i"~• TELEPHONE DATE <br /> prepared under m. direction nr wla•n i.iun in accordance with a s}s[cm dcs{gned • <br /> to uswrc that qualified peratmnel prnprrly gather and esaluatr the inlormagat <br />h <br />h <br />t ' <br />~ <br /> suhmittnl. Fta.rd on m~ inquin of the perx.n or persons w <br />o manage t <br />e sys <br />em. <br />or thtw• la•rvms directl} rrepmsihle for Kmheting the information, the information <br />I - <br /> vthmittrd i+, ht the hest or m. knowledge and heliel. trot, art'ul'a1c. artd anmpMlr. <br />SIGNA,IrURE OF PRINCIPAL EXECUTIVE ~ ~ I ~ <br />TYPED OR PRINTED I am aware that them arr.ignifir+nl prnaltk•.ti for wbmiuirtg ful.e information. <br />imiuding the pmsihiliq ~>( 6nr amt impris xtment fur knowing ci~dations. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />.S <br />~~ <br />'.' I• Thi` is a 4-cart f<tm~. PAGE OF <br />