Laserfiche WebLink
FormApp ~; <br />IJATIChJAL POLLUTANT DISCHkRGE EL(MINATIOPI SYSTEM ((NFD ~} ON16 N0. ~ll0~OG04 <br />DESCHARGE MONITORING REPORT (DMRJ - I ~ ~ <br />_ „~!. <br />'PE9MITNUMBER DISCHrARGENUMSER ' - <br />i <br />~~, <br /> <br />t <br />V .~~'yi{~ ,J <br />N (' <br />N <br />v <br />`7 <br />0 <br />o .~ <br />N <br />iL .. <br />U <br />ILL <br />0 <br />C7 <br />z <br />z . <br />a <br />z <br />~ ' ~~~~. <br />z . <br />o~")III <br />. _~ <br /> <br /> <br />~IIJJ <br />kl !~ it 'I <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />-; _ _ <br />- MONITORfNG PE€kIOD <br />FACILITY ~ <br />--- <br />l , _ <br />DRY <br />DAY <br />YEAR MiQ <br />YEAR NIO <br />, <br />.. <br />_ __ <br />LOCATION ~ j `,r .. _, FROM <br />TO <br />:_,-, ` .,~ ~ r; .' ;;~.~ ,,~ ~; ' ~ ,: ~;~ i NOTE, Read Instructions before completing this fh~t, <br />PARAMETER C3UANTITY OR LOADING QUALITY OR CONCENTRATION Np• FREquENCV SRMPLE <br /> <br />~ OF <br />$(PE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />~~ 4i "SAMPLE 3`~ r-z ~*.; .:.:...:......:. ~ # :r ~ <br />L <br />i ;. ~•~ <br /> MEASUREMENT <br />:: I <br />~ <br />r <br />~ . -:t <br />r .I Pr" r~r ~c,~ ~t i t RE~~~"sE1JT ~~ <br />~ ~ac,~ <br />~ <br /> <br />.i <br />1L 5.. .. .. ~ <br />~t.~~;k~~(~'::~=t~ <br /> <br />SAMPLE <br />MEASUREMENT .~ ..~'. <br /> <br /> <br />~ <br /> <br /> <br />I~, ~SCbt~t .~ . <br /> <br /> <br />~ <br />,~ a ~ , - p~~k'j~. <br /> <br />~:r <br />,, , ~~ <br /> <br />. <br />- I - ,~. <br />! <br />1:T <br />! <br />~;a~~ <br />. k~ <br />~' <br />~ REOk~t3EfJT . ~ }. <br /> <br /> <br />:, <br />I <br />~ ., <br />.. <br />~,.., <br />,M. , <br />i <br />. <br />..:. <br />_L. <br />.. <br />, <br />~. <br />. ,~ <br />... <br /> <br /> <br />_.!= <br />~;?_ ! '. ~ : i..! <br /> <br />SAMPLE <br /> <br />~ ~ ~ <br /> <br />; ~_ -- <br />i. = m: ; <br /> MEASUREMENT <br /> ~ ~ , , , <br />`f L..t~.~t ~ . : f. "?~ .a d ~t';: REQUIR~~iENT z I~•s ._. ~ ;~ ~ <br />w. i ~ I ~~' <br />,,_~,.,, _ <br />SA <br />MALE :_;; : ~ . _. - -. a -t <br /> MEAS <br />r_,1 4 I PERA~kT - - ~r <br />~~t I r'a- r e.~ =~~I <br />}-, .. t, L.1`! i 7.4 ./y~ ...., REQUl66~~~~[{{hJT I <br />F4.4.iM/M <br />^ <br />~ <br />t' <br />~ <br />r <. <br />I <br />;. <br />.._ _,. <br /> <br />~. <br />SAMPLE <br />:*~- ~, { i <br />~ MEASUREMENT <br />~ <br />~~ <br />r <br />- >, <br />~17 r <br /> <br />p t i~ ~, ~~ ~r.~ i i J~ ~ <br />RfU <br />LI<~~trT 1 <br />., ,... <br />r e. T <br />I .':r r` i ~ , <br />i <br /> . <br />;'??i s~i:Tii "'r> yy7.;, <br />- - -, - <br />SAMPLE 'r4a~;wy.'=- ,';~, .~., .;, -a :. s~~.,..... i .,•,rt <br /> <br />I MEASUREMENT <br /> <br />t't ~k <br />P~>'!~~~ ~ <br />~ <br />i <br /> <br />~ <br />k,~~l...l;_'~; l:4,1" r? t'e~=ti..E. <br /> <br /> <br />mot. *' ~ .", ` `-'f~i~ji. iRi~ RECd~RET~ENT~ <br /> <br /> <br />SAMPLE <br /> <br /> <br />- <br /> <br />.: <br />r'1t <br />_ .- <br /> <br /> <br />-:. ,.., ., ~ <br /> <br /> <br />.:. ,... <br /> <br />I, <br />~ =! <br />,. ,.., ., ., I`'`i.. . <br />~ <br />r I <br />J~;r' ! ' z; ~ ? °( i~ ~ ~; ~ ~ MEASUREMENT <br /> <br />_ ~ i~ <br />..-- <br />~. <br />. <br /> <br />... <br /> <br />~~~ L wa~ ~k? .~,td...t~.!F ~rr~^.?..=1 'Y <br />a <br />REOU •; <br />NIE~1T <br /> <br />- <br />r,, t <br /> <br />__ <br />~ <br />.v 1.~ <br />„~„n ', I <br />'" <br />4 <br />.: <br />NAMEITITLEPRINCIPALEXECUTIVEO FFICER Icertifyunderpenaityoflawthatmisdocumentandaliattachmentswere <br />d TELEPHONE DATE <br /> prepare <br />under my direction or supen~sion in acmrdauce with a system designed <br />~ p <br />W;k`~0.~ '~ Zr to assure that qualitiedpersonnel properly gather and evaluate the information <br /> submitted. based on my inquiry offhe person or persons who manage the system. <br /> orlhose persons directly responsible for gathering the information, the information <br /> <br />o <br />0A f <br />~ <br />~ <br />submiltedis, to the best of my knowledge and belief, true, accurate, end complete. /~ q <br />. ~'~ y~ <br />(~ <br />~ <br />7.J <br />~ <br />r <br />~ <br />' U~" lamae5zrethaltherearesi <br />nificant <br />enaltiesforsubmittin <br />falseinformation NATU OF PRINCIPAL EXECUTIVE V 9 <br />~t0` 0 l <br />TYPED OR PRINTED g <br />p <br />g <br />, <br />including the possibilityaffineandimprisonmentForknowLigvioladons. FFlC RORAUTN~RIZEDAG'eNT AREA <br />CODE NUMBER YEAR MO DAY <br /> <br />