Laserfiche WebLink
PERMITTEE NAME/ADDRESS Ilnrladr F'arili(r .1'amr/lnratinn iJUiJfrrrntl <br />NAME ~ ' <br />ADDRESS <br />,- 1 <br />FACILITY ti_.i•K S ~ -'. <br />LOCATION f; i (] v j " ~- ~ <br />I`1kRlC:f: WFiDe--. f`?INE M,OIIt~~G~R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DA4R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />~:G i {~ TL ~ <br />Form Approved. <br />OMB No 2040-0004 <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 ~ , ~ .~.~ .a. . •a ii ( - - - . <br /> .REQUIREMENT { ~ • <br /> SAMPLE • <br /> MEASUREMENT <br /> PERMIT -,. ., ;r ,. ... <br /> REQUIREMENT `/'' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , . ~. t • y- z sr : -:. s; ._ .._.: _~ _ <br />I REQUIREMENT ~ • == f I"~-~ <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 />NAME/'fITLE PRINCIPAL EXECUTIVE OFFICER I certih wider penalts of law that thi+dncument and all utuchment were TELEPHONE DATE <br />prepared under m. dinrYion or supervision in acrordnra•r with a +~st+m: duigncd __- - ~_. <br />to n+eun thm yunli0rd prrw:nm•I properly guthor and e~ aluute the in(urmatinn <br />- _. - ~_- -- wbmitted. Based ,»t my inyuin n(the prnun or petwns whn mutwgr the +y stem, j f <br />or th:wr prrann+dvectly rr-spomiMr for g»thering the Mfnrmation, the information <br />~ ' ' <br />~ <br />- <br />~ • <br />: <br />~' +ubmil[ed is, to the best ~ my knowledge and taahr, true. occurutr. and complete. <br />~ <br />SIGNATURE OF PRINCIPAL EXECUTIVE - <br />~ ~ ~ / <br />I am aware that there are slgnificaat penalties far whmitting false inG.rmatlon, <br />d i <br />i <br />m f <br />k <br />:wi <br />si:d <br />r(a <br />s <br />l <br />d <br />h <br />hillt <br />f M OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />e pm.i <br />mpr <br />wmmr <br />ur <br />ng <br />a <br />n <br />. <br />u <br />ln4 t <br />y o <br />r an <br />a <br />• TYPED OR I~iINTED inc <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />,-, n,:o r>,:r+ or::r:, rrZn rrHC~I?F7Tri, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used <br />OC}4`t': This is a •~ <br />OF <br />