Laserfiche WebLink
PERMITTEE NAME/ADDRESS tlnclude FacilGi .1'amr/Location iJDrffennrl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />- -'~' '/'1 '"' ~'~' YEAR MO DAY YEAR MO DAY <br />LOCATION ~ F_N FROM TO <br />G.IAt'1. RFt:I <br />F;rn ApFr~.ve,''. <br />OMB No- 2UaU-UGCa <br />a • ~s <br />F - ~ ~IaAL <br />rt~f; N(y TO ~rR I D ~NUDD.PRSON GULCH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ j ~ I ~ , <br /> MEASUREMENT ~ ~ <br />~J I -~ ~ v <br /> PERMIT <br /> REQUIREMENT ' <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT '- <br /> SAMPLE <br /> MEASUREMENT ~ <br /> PERMIT ' <br /> REQUIREMENT <br /> SAMPLE <br />~ ~ <br /> MEASUREMENT I <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />~ / <br />I <br />~ <br /> MEASUREMENT ; -- / <br />` % ' ~J <br /> PERMIT ~ ~ .: _ <br /> REQUIREMENT " ~ I f"' <br /> SAMPLE ~' ~{ <br />!` G <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />( ~ ~i ~) <br />' <br />d ' ~ <br />(` <br />l/ j <br />~ <br /> MEASUREMENT - v <br />" - <br />` <br /> PERMIT ... . <br /> REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I a'~'rtify under prnuh> ~~! Iaw that thi+d~Kameat and au atmahment+ weer TELEPHONE DATE <br /> prepared under m~ d{rra bun or wpeni+ion in aecurdam~r with a e.drm designed <br />' <br /> i~~ u•mrc that yualifiad prrumnei pnrprrl~ gather and e~aluau• the information .t <br />' <br /> +ubmittal. f3a+rd nn m. inquiry of the perum ur percon+ whn munage the atem. <br />ur thrnr prrutn+dinrtl~ respmsibk fur Kathering the information, the information ~^ <br />~ -- <br />/ <br />l <br />~ `~f <br /> rau <br />utr <br />d <br />o <br />h9 <br />k <br />i <br />d <br />d h <br />li <br />l <br />t f <br /> now <br />. <br />rue, a <br />r <br />, an <br />r <br />mp <br />e. <br />mbmittrd i+. to the beet o! m. <br />t <br />gr an <br />r <br />r $IGNATU E OF PRINCIPAL EXECUTIVE ~•~ <br /> 1 am uwarr that there are significant prnultic+ fnr suhmittinK fal+e information. AREA <br /> rhunmrnt !or knowing sirdalion+ <br />the <br />rr+iMlin a!(ne and im <br />i <br />cl <br />di OFFIC R OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED p <br />. <br />n <br />u <br />ng <br />p <br />COMMENTS AND EXPLANAIIUN Ut ANY vIVL.Allvna Irrererence an affacnmenrs nt:re~ <br />'. F ?,!Z~ tr+~ LIMIT Pot_I~D Ff?k <=tOVR, 244-iR PRFC?° FUFN~Ii <br />Thi. i, :i ! r~:.r! f ~~ PAGE OF <br />cva Fo;r,- 332:~~? ~Pev 3x'941 Pr_. __,, :^~,r~-.~~_ ~nr_ ~_ ,__. r,~ <br />