Laserfiche WebLink
run a r+ppiveeu, <br />M1ATiOhIAL PQILUTANT DISCHARGE ELIMINATION SYSTEM NFL~ESJ OMB f~lo, -0GCn <br />DISCFSARGE MONITORING REPORT (D R) ~:>,; <br />! ~.- <br />.; ! ; <br />i <br />-; <br />NUNIbER I -` <br />PERrPITNUMBER ClschARGE } - ` <br />~ _ <br />MDNlTORiNG PEr~lOD <br />,. <br />'YEAR MO. DpY YEAR MO_: DAY -, <br />FROM ~ TO ~ ~ ~ ~ ~ ~ ~ ~- <br />NOTE; Read Instructions before completing this faro. <br />:, <br />:~ <br /> <br /> <br />';~~aa <br />m~ <br />N <br />N <br />N <br />o _.~ <br />O `~j} <br />0 <br />c~ <br />z <br />s <br />a <br />r <br />z <br />w •• <br />~ :.. <br />z <br />r14'~ ,ry <br />N ''~ <br />r„ <br />~~~IF~u <br />.,~ <br />d <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FAEOUENCY <br />OF S&MPLE <br /> <br />BYPE <br /> ANALYSIS <br /> AI+ERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />•- <br />I~ 1 r a SAMPLE <br />MEASUREMENT '" I <br />D l r.SG <br />G ~'ti <br />;. P ~ ~ ~ 1 _ <br />li I t 1 -.. / i <br />~.~ f ...t 14,.i+' S'1~5 L.1l;,i:... .. '. t~'1 Rt~QLf~ ENT ;C "Z' ~• ~ :r14yY % i.. <br />L__ <br />__ <br /> <br />j t I M1~, , y~ I ~ a'.. •~1 `.} i", <br /> <br /> <br />AMPLE <br />,: ';; '~.'+~.'i .~... <br />;: t, <br /> <br />.,. <br />e ' n ,..... <br /> <br />~ ... <br />r. r. , .~ ~.. <br /> <br />.:....r: <br />n . ?yi^^. iT <br />' <br />`_`."{.1.. MEASUREMENT <br />- I <br />~~ , ~ , ~ P~ "~ <br />~~' ~ .t, it xF <br />~ ~: <br />rf r ! 't; i.i'! ic; s r^.~.'laC RE4UIRE#IIENT ~ I 4:....1 i ,. .. <br /> <br />SAMPLE _ _ <br /> <br />~ _ <br />I MEASUREMENT <br />-~ <br />1 .. <br />~'33A~44T. I <br />>• <br />4 REOU[R~fJf~NT I <br />i <br />~ SAMPLE _ _ _ <br /> MEASUREMENT <br /> PER~y-kT <br />~ <br />, <br /> REQUIFfE~IENT <br />- ~ <br />~ ~` <br />J <br />~ SAMPLE -- <br /> MEASUREMENT <br /> PRMIT I <br />' <br /> RI=QUIF~~k~~tT <br />SAMPLE ~ ~ , <br /> MEASUREMENT <br /> PERIE~IT I ; i ' i <br /> REQUIREh1E1JT ~ ~ I ', <br />I <br /> SAMPLE ~ ~ ~ <br /> MEASUREMENT I <br />~ <br /> PERMIT ~~ -- <br />i -- <br />_ ~~~ <br /> REQUIRE~E~JT <br />NAMEfTITLEPRINCiPALEXECUTIVEOFFICER . Icertifyunderpenaltyoflawthatthisdocumantandauattachment:were <br />~ <br />a <br />d TELEPHONE DATE <br />Q _ <br />t~Ill,c.a~ D~~ ~y (', prep <br />re <br />under my direction or superrision in accordence with a system designed <br />to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br /> or those persons directly responsible For gathering the information, the information A <br /> <br />lf <br />s <br />~ <br />submitted is, totbe best of my knmvledge and belief, true, accurate, and complete. ~j1() <br />O <br />9 -S <br />y~ <br />V <br />D ©~ <br />M <br />``U <br />t!'0. Iamuwarethattherearesi <br />enalfiesforsubmittln <br />ifi <br />t <br />fal <br />i <br />f <br />ti IGNA RE OF PRINCIPAL EXECUTIVE l / a C <br /> gn <br />g <br />can <br />p <br />se <br />n <br />orma <br />on, OF CERORAUTHORREOAGENT <br />TYPED OR PRINTED incfudingtbepossibilityoflineandimprisonmentforknowingfiolationa, CODE NUMBEfl YEAR M0 DAY <br />.,_ I,UIVIIVICIVIJ HIVU CAYLHfVHI IVIV Vf• HIVY VIVLHIIVIVJ (tYBTef@RC@ dl! 21'[aCpln@tl[S Ae!'dJ <br />3 ~ 3 1 <br />t.Z }"<~i 3.~. .... <br />:I Goa c~,m aeons row,. ornm --. ~_ „__~ !- _ m:;.:;T:~ _ .A, „:...dr~_. _ PAGE ;TOF <br />