Laserfiche WebLink
PERMITTEE NAME/ADDRESS i-nrladr Fadlity;l'anu/l.nratwn if IhfJtrrntt <br />NAME J` :1,, ~ . , ~ . <br />ADDRESS !.'. (" : P.! ; - <br />~:) tr?r3 <br />,';? » 1 <br />FACILITY ;-y~j~~~G~'•'• ;'~ L~'~L <br />LOCATION ;_~ ~ ,-_ ~ ~ L <br />l.t~-1CE Ed~IiEr ['iIf4c. i`3At~iAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />~ ~-~Uir\ l"i~'i <br />M - Z NTER I i"! f''1N <br />•;r,:,rn-hlF rent C? Tn CAI_AMtTY DRAW <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />E FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> X ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />'.~"- MEASUREMENT ~I I ;• : ~. <br /> PERMIT -, - - :. ~ .: ~ . <br /> REQUIREMENT _ ;.: -, :: ;. <br /> SAMPLE <br />~ <br />'~ ~ _ <br />~ <br /> MEASUREMENT - ~ - <br /> PERMIT - .... ;;~ t; ;. ~ ... ...., .. ~ ,. .... <br />.. REQUIREMENT li~~X <br /> SAMPLE i <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 rerun under penalh u(law thm thls document and ali attnchmcnts were <br />stiu <br />n <br />vi <br />di <br />a <br />I <br />i <br />• <br />ith <br />t <br />d <br />d <br />d <br />i <br />i <br />d <br />- TELEPHONE DATE <br /> prrpurr <br />wt <br />rr my <br />n <br />n <br />r , <br />prr <br />on <br />n accurt <br />am <br />e w <br />a +yc <br />em <br />v <br />rs <br />ane - - <br /> tw accurr that yunlificd peraonnrl pruperl/ father and e. alunte fire inforntat4ra --- <br />__- _ - cuhmNtrd. Baud nn mp inyuin of the person or perwrns who marwgr the ryarm. ~ - <br />~ <br />_ ur ihrnr per+om dlrccth roprnniMc fur ~atM•rinA the Information, the information _ <br />-" <br />~ - <br />~ <br />. , <br />~ ~ +uhmiucd b, ur the trHt of m~ know Ird>;e and hriicf, true, accurate, and compktr. ~ ~ <br />•' O <br />, <br />' -~ <br />I am nwure that there arc ,Ignifk-ant pcnulti++for whmUtink fulx information SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br /> <br />TYPED OR PRINTED . <br />rmiadir>R thr pussihiiitp of fine rod impriammrm for knowing +iwlatiwnx <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />wmm~rv t a r~rvu ~nrt~rvia t wrv yr Nrv 7 vtvu~ I Ivrva (tYel@BlIGI? d!I dfi%iGlIfTIB~l15 r7el@~ <br />1.-TMI' <br />EPA Form 3320-t (Rev 3199) Previous editions may be used. <br />,G3G =: This is s 4-part form. <br />