Laserfiche WebLink
PERMITTEE NAME/ADDRESS 1lndudr Fuifitr :~'anee/Lxariun iJJhJfrrrml <br />NAME , <br />ADDRESS : ~ ~ ~ Lei ,ice. !... <br />b70 <br />,~ a . .t, <br />FACILITY _ ` .. i'l I NE ~~I-`'' •': <br />LOCATION , J ~ hJ , ~, <br />r' G.Akfl. RF~"1 if'3ri71f:~.i PtAiVF'..-~_~', <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO OAY <br />FROM TO <br />Form Approved. <br />OMB No. 2$40.0004 <br />I`/irhi•i,~~ ~ <br />5~~ ~~ ~~ <br />L~S~ HG T© TR I f31I?RY S <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING DUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />SAMPLE <br />.. i <br />' <br /> MEASUREMENT - <br /> PERMIT <br /> REQUIREMENT ~ ' <br /> SAMPLE <br />~: <br /> MEASUREMENT <br /> PERMIT <br /> REDUIREMENT - <br /> SAMPLE ~I <br />~ <br /> MEASUREMENT ~ - <br />' I <br /> PERMIT ' n <br /> REQUIREMENT L~ r <br /> SAMPLE <br />~ <br /> MEASUREMENT - <br /> PERMIT r <br /> REQUIREMENT <br /> SAMPLE _ I <br />~ <br /> ~ <br />` ' ` <br />,~,,, , ,..:_;~ MEASUREMENT <br />' '} PERMIT ~ , <br /> REQUIREMENT <br /> SAMPLE - n i _, I <br />l <br /> MEASUREMENT <br /> PERMIT J' ~ <br /> REDUIREMENT <br /> SAMPLE <br />~' U <br />< `~ ~` <br /> MEASUREMENT <br /> PERMIT :~ _ <br /> REDUIREMENT ~'"' '' ` <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER { s'rrtir~ under penal[. of law that m{+documrnt and all atWChment+were _ TELEPHONE DATE <br /> prepared under my dlm lion or +upcnision In asxurdurree wilh a sdrm dr+iRned <br /> dt assure that yuulifird prrsomtel properly {ryther and eyahaete for information <br />n <br />the syst <br />m <br />h <br />iu <br />f the <br />w <br />o <br />o <br />s who m <br />d <br />R <br />d <br />I <br />l ~ <br /> , <br />su <br />m <br />. <br />ase <br />~xt m~ <br />nqu <br />n o <br />per <br />r pen <br />n <br />a <br />age <br />e <br />e <br />m <br />or thox persons d{rertl~ recp`mslble for {tethering the information. the Information <br />~ <br /> and cumplrte <br />submitted is <br />to th <br />bee or m+ knowkd <br />e and hrlicL true <br />rcrurate ~ ~ f <br /> , <br />g <br />, <br />, <br />. <br />e SIGNA~URE OF PRINCIPAL EXECUTIVE <br /> I em awarr that thrre nre .lgnlRcam prnaltle+ for +ubmHtinR false information. <br />si <br />ibilitc <br />t f <br />r k <br />wi <br />l <br />No <br />i <br />l <br />di <br />h <br />l f <br />d i <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MD <br />DAY <br />TYPED OR PRINTED ine an <br />mpr <br />sonmen <br />o <br />no <br />ng <br />u <br />a <br />ns. <br />or <br />u <br />ng t <br />e pus+ <br />u <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />' ~IREfl TO RE~rJEST A REA50NASLE ~'OTENTIAL ANALYSIS DE <br />EPA Form 3320.1 (Rev. 3/99) Prevlovs editions may be used. r1007~~ ' This is 13 4-part fbcm. <br />