Laserfiche WebLink
PERMITTEE NAME/ADDRESS pr.crJr F.e~bryN../L«rtw yDtQG.w~t) <br />NAME <br />ADDRESS .. A ... ~ ., _ .. .. ._ ~ '~ i :. . ~ ~~ ~ .: <br />s;01 l~ j:; <br />LSADc CO b~~~6 <br />FAaLrn SIDL RUlsih t :iUU':H :1IN!~.; <br />1OC'~'~ YALiSf Ui; C:0 b15LD <br />.:n-t t r-l;t~~:, u <br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SY8TEM NVDESI <br />DISCHARGE MONITORING REPORT /D R) <br />PERMIT NUMBER aSCHMOE NUMBER ,~ <br />MONITORING PERIOD - <br />YEAR MO DAY YEAR MO DAY <br />Form P.pproved <br />'JMEi No ?C40-OOG4 <br />FROM TO <br />NOTE: Raad Inatrvctltxta Dafwa~oinplatinp thla fam. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCV SAMPLE <br /> OF <br /> EX ANALYSIg TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />~ ~~ <br /> MEASUREMENT <br /> <br /> <br />. , .. ~ _ PERMIT <br />r i <br />.. <br />_ ^. i.. <br />' , ;: <br /> REQUIREMENT <br /> <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 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PER MIT <br />REQUIREMENT <br />t «rttt.. er pen. ty . l.w th.l NH dorumenl •rd .4.1lKhmenls were <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />d <br />d <br />l <br />l <br />DATE <br />prsp.re <br />rrmyel,.~lbnor:„oer,tt <br />un <br />on <br />n.no.e.nR.uh.,rl.md~in.e <br />to ~rs thel qu.Mfled personnel properly L.IMr end e•eluelr the Infnrrrullon <br />fnbmllttd. Bred on mr Inquiry r the person or persons who mutaRe the rytlem, <br />• - M Ihou persoro dl redly respeinlbk for ~.Ihertn~ thr Information. the In/ormsllon _ ~ `., <br />submllled b <br />to the brst of m7 lnawkd~e and betlef <br />true <br />ac <br />nt <br />nd <br />m <br />kl <br />- <br />~ <br />. <br />. <br />, <br />cv <br />e, a <br />Iv <br />p <br />e. <br />_ <br />1 am ^.are Ihal there are tltnltlcant penaltlea for wbmlttln <br />fabe informatb <br />6fONATVRE OF -AINCNAL EXECUTIVE <br />TYPED OR PRINTED j <br />n, <br />Includlnt the porelblUty o! fine and fmprbonmenl for AnowlnE Hdatloru, OFFFCER OR AUTHORIZED AGENT CODE NUMBER PEAR MO DAY <br />COMMENTS ANU tJll'vtnA t Ivrq yr nn r •tv~n t tuna frfanrtrnc• svi arracnmtrnra nttvtq <br />EPA Form 3320-t (Rev 3'99) Previous editions may be used This is a 4-pan forlti. PAGE OF <br />