Laserfiche WebLink
PERMITTEE NAMElADDRESS Nnctudr Facility A'ane/lotaNan if rh;(JerenU NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY ;,,,,. I,+ t ;,,~_ MONITORING PERIOD <br />LOCATION ;-,riy FROM YEAR O DAY TO YEAR MO DAY <br />` t1.t~Rt1, i?Fi: <br />Form Approved- <br />OMB No. 2~0-0004 . <br />• ..~~L,: <br />I< - f i 1'- , - ~ ' <br />D~CHc; Tf3 rR I [3 ~ = 4GE CF2'=EK <br />~I <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 /> 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 - f' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I crnif> undrr Ixnalry of law that this dtkument and ull nUUChments were <br />~ <br />/ TELEPHONE DATE <br /> tiun or supra ision in accordance with a system designed <br />prrparrd undrr mr diraa <br />r <br /> to assure that ymlifiad personnel pruperh gather and esalun4• the infnnnation '- <br />' <br />~ <br /> whmitt d. Bard on mr inyuin or the pcrstm ur prr+amc whn manage tkr .y+trm. <br />wr thine penuns din •th n punsible fur gathering the information, the information , <br />~ ` <br />' ~"~ <br />~ <br />-~ <br /> submitted ls, W the hest of m~ know ledge and belief, tnee, uceuratr, and campktn $IGNAT~(1RE OF PRINCIPAL EXECUTIVE l <br />"" - ~ ~ I <br /> <br />TYPED OR PRINTED I am a.. are that them an significant penalties for submitting false information. <br />including the pasabilin of fine and imprisonment fur knowing sldatinna. OFF ER OR AUTHORIZED AGENT AREA <br />D NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Hererence an anacnmenrs Here/ <br />I~11~ I> :I -1 I~:Irf !v~lm. PAGE OF <br />EPA Frrr~ 3=sZC-? ',R~ v 3;9~+ Fr2vio~5 e~99.Jn5 n°'s: '_ <br />