Laserfiche WebLink
PERMITTEE NAME/ADDRESSllnrludt Farilu-:1'arnr/location iJDiJJrrrnU <br />NAME <br />ADDRESS <br />FACILITY `~lClf'? i .. .:: ;`: ` i'~tG <br />LOCATION A ~'- C O ~ 1 s? c~.i <br />L;19?V~~ WAI?: "lINI" `'tANAGEft <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMRJ <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 fVO, FREQUENCY SAMPLE <br /> <br />EX OF <br />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 ~ ~ ~-~f <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <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 .. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - <br /> REQUIREMENT - ~" ' <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I r'rn'f> under IK•twln of law that Ihi+doeument and all auarnmrnh »rrr <br />vlion nr su <br />•ni iun in aa <br />ord <br />cr with a +.+tem d <br />iptted <br />arxd <br />der <br />. di TELEPHONE DATE <br /> prrp <br />un <br />m <br />rr <br />p <br />c <br />au <br />r, _ ~_ <br />~- - <br /> h, a+wrc That yoali6rd prr+,mnel pngxrl~ gatltrr and c~aluatr thr infurmrtiaa <br /> +uhmitled. Rand orl m. inquiry of the perx,a or perwm who manage thr sy+tcm, ' <br />~ <br /> or th,nr pcruau din•.al~ rrspomihle for gatherittg the infurtnatlon. the informatirm _ <br /> +abmitted h <br />In the hrd u(m~ l:mreledge and hrHef, true. accurate, and compute. . <br />- <br />• , <br />itti <br />ti <br />h <br />U <br />i <br />ifk <br />t <br />ltt <br />f <br />b <br />f <br />L <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE = <br />TYPED OR PRINTED• ~ an <br />pena <br />e+ <br />or +u <br />m <br />og <br />n <br />orma <br />1 um aware t <br />at <br />,rrr are+ <br />Rn <br />a <br />+e <br />on <br />including the prsihBih d finr and impri.anmem for f:nowing rf,dutioa+. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />-~-H ~5r- _., Rr. _ F'r~~v~a. ati--,._ . _ TI11~ I• .! -+-ilaTl il~l~ill- Ynlat OF <br />