Laserfiche WebLink
PERMITTEE NAMEJADDRESS rlnrladr Fnri(ity .YamdLocerion iJUifJrrrnli NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DA4R) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEA 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 <br />NO. FREQUENCY <br /> <br />OF <br />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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ - ~, a~ ~.. t -: ._ ~. , <br /> AEQUIREMEN7 _ :~ ; <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER 1 certih andrr prnaln otlaw that lh{] d(K'UrIR'nI and aII altaahmenll N'PR <br />d <br />d TELEPHONE DATE <br /> rsigne <br />prepand umlrr m~ dirtctbn or +uprrvisiwn in accordancr with a s~~tem <br /> to assure that qualified personnel prnprrl~~ Rathrr oral rsaluatc for information -~ <br /> submitted. Rxxd on my inquin of the person or penon+ who manage the s~aem. <br /> or Iho+e perwn+ directly resp>nsihk for Ralhrrir~ the in(wrmution. IM• information <br /> submitted h, to thr hest nt ms knowledge and belief. true, acarrate. and completr. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 1 am awarr that tM•re arc +igniricam pcnaltirs fur submitting false in(ormatian. <br />in•luding thr Inxsih{lin of fine and imprisonment Grr kmrwing siaiatirmn. <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY <br />(Reference al( attacnments Here) <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous eddions may be tsed. This is a 4-part form. <br />