Laserfiche WebLink
PERMIITEE NAMEJADDRESS llncladr Foti6n .1'anv/locmion if Urfjerrn!! NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS r,u;t 1. ~)it <br />B~~( f~2; PERMIT NUMBER DISCHARGE NUMBER <br />' -A MONITORING PERIOD <br />FACILITY j-{OH LZ17t~1 f~ <br />YEAR MO DAY YEA M DAY <br />LOCATION i_A (_ :-_ FROM TO <br />i enlr t: ~.I:S.i1F .-i ~ t.lF MANA; : N <br />Form Approved. <br />OMB No. 2040.0004 <br />Ltii~G TR IB TC <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY <br />DF SAMPLE <br /> <br />EX <br />ALYSIS TYPE <br /> AN <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT. <br /> <br /> PERMIT •;i .S, ~; ~•: .... • ' ~at~{ , <br />' ~ v , <br />~ ~., <br />• ±r4 V <br />f"f-i{`.'. T!. <br /> REQUIREMENT ' + A VG <br />;, i~A F t _ <br />; <br /> <br /> SAMPLE <br /> MEASUREMENTI <br /> PERMIT " " <br /> REQUIREMENT -. :.;~,~~ Lr; : ~-'~• ~ , _ <br />SAMPLE <br />MEASUREMENT <br />,, <br />. <br />• PERMIT ~.?z^ air ii ii ~ :i , i JK t * ~~" _ i _ <br /> REQUIREMEN7 ~;~.••'t=. ?~; i ~_ r `it: - <br />`. ~ ~ SAMPLE <br />:i MEASUREMENT <br /> PERMIT w,-_,<. r: ;, ,. ,:. ~ ~ ~x : ` • ! ~ gin. _ <br /> "ti-DA ~~•v;-: T=~~; ; t_ ~., - <br /> :REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .: ,. , <br /> - _•~~LIA -~~ '3 t'AILY ;-'.~ <br />- REQUIREMENT <br /> <br />SAMPLE :'v <br /> MEASUREMENT <br /> PERMIT ;: .. , r ~. ~ ~ - ~... .. t ~ <br />~ . _ <br />' _ <br />I•'' <br /> ~~ <br />~~ r",~, ! <br />;v, . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ., ~ _ f . _ <br /> REQUIREMENT _ <br />_'•=~ ~ •~ Dt~, I i_ .-''x <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER i crrtir} noder prn:dn ..r mw that this d~xument and all uttachmenfi wrre TELEPHONE DATE <br /> preprn•d undrr me direction or wprnision In wrnrdam~e xith a xJxtrm drsiyr,rd _ ~ _r- <br /> io u++ure that yualilied prrwnnel grope rid gathrr and c+duate the information r / <br />~ <br />- - - - submitted. Rr+ed im m~ inyuin of thr prrson or pen«u who munagr the .csiem, <br />erwns dimll~ ra.lam+iMc fur gathering the infurmation, the infurmntiun <br />ur thnxe ~~ a - <br /> <br />~ _~ p <br />whmiticd i+. to the Ixrt of m. knowledge and lerik4 true, ucrurotc, and avanpktr. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />~ i - - ' <br />~ _ <br />- ' ~ <br />J <br />- I am awurr that there are signifa: rnt penalties fur +ubmiUing fdx iofurnwtiua. <br />D AGENT <br />TH AREA <br /> ci,dmions <br />rC+unment fur knuwla <br />ibilit <br />f ti <br />d i <br />i <br />h OFFICER OR AU <br />ORIZE NUMBER YEAR MO DAY <br />TYPED OR PRINTED • <br />g <br />~ o <br />ne an <br />mp <br />includ <br />ng t <br />r po+s <br />COMMENTS AND EXPLANATION OF ANY <br />frfererence an arracnmenrs nere~ <br />EFA Form ?3ZC~ ~ iRe: "i'9.! Pr~t~icus ~~d.t~or= _ - . <br />