Laserfiche WebLink
PERMITTEE NAME/ADDRESS /lnrludr Farilin~ 11'amrgttcotiort if Ihfferrn4 <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <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, <br /> <br />EX FREOUENCV <br />OF SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <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 <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER 1 ~rrbp unary penau~ nt law that this document and dl utwchmrnts wrre <br />i <br />i <br />i <br />d <br />h <br />d <br />i <br />d TELEPHONE DATE <br /> <br /> <br />- prepared undrr my direction nr wperv <br />s <br />on <br />n ncrnr <br />nncr wit <br />o .yytrm <br />e <br />gne <br />W ussnre that yualifird pcrs~mnd prnpcrl7 ynther rod cs rluate the Inrnrmatlnn <br />snhmittcd. Mased on my inquin of the person ur prrxms w ha mnnaite tlx• .Farm. <br />or those penuna directly mgmsilsk fur 4atherirtg the infurnwtion. the information <br /> whminyd is, to thr best of ms knnwledKe and belief. true. accuratr, and complrte. <br />f <br />h <br />i <br />f <br />l <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED orm:ni~~n. <br />1 am aw arc that there are siKn~crnt penrlttrs <br />ar su <br />m <br />tting <br />se in <br />a <br />iMludinR the pasihilit~ of 6nr:utd imprMmmrm for knuwinE siolati.~n,. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a!! attachments here) <br />EPA Form 3320-t (Rev. 3199) Previous editions may be used. T}llt lc ~i -3-~1~1TI fOittl. <br />