Laserfiche WebLink
PERMITTEE NAMElADDRESS ilndudr FariGf~ ,\'ante/loradon if IA;(frrenll <br />f NAME <br />ADDRESS <br />FaclLm <br />~ LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approves. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX 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 /> 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 crrtif~ under prnaln of law that this diMUmenl and all almchmcnp were <br />di <br />d <br />d <br />i <br />hk <br />f TELEPHONE DATE <br /> prepnrr <br />un <br />er my <br />an or wpen <br />rrct <br />m <br />n urcurdanre With a s)arm dcsi>;mYl _ - - <br /> lo assure that yualifkd prrwnnel properly >Zathrr and cvalunle the information <br />- --- submitted. Na+rd on m. inquin .J the person or ptrwtu wha manage the system, <br /> or th~nc prruuts dirrrth respondble /or ¢atherinA the information, for information <br /> wbmiited h, to the best of ms knowledge and belief, true, accuruta and r~anplete. <br />I um aware that there urr si <br />nirtrunt <br />xmultles far wbmNtin <br />Z luls <br />infur <br />Gu <br />SIGNATURE OF PRINCIPAL EXECUTIVE t <br />" <br />TYPED OR PRINTED g <br />I <br />i <br />e <br />ma <br />n. <br />imindimt the ixn.ihllit~ ..r rm• and impri.onmrnt l..r Avowing si~datians- OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />GUMnnen I ~ Arvu txrLnnA I wn ur Anr vIULA I IVnS (He-erence all anacnments Here) <br />EPA Form 3320.1 (Rev. 3!991 Previous editions may be used <br />This is a 4-part farm. <br />