Laserfiche WebLink
PERMITTEE NAME/ADDRESS rlnrludr Furihn .1'umriLxanun iJUiJJrrrntl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMRJ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />QMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT - ' <br />SAMPLE ~ <br />~ • <br />MEASUREMENT <br />PERMIT .. - f: ,--. ~ :" <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT - .,. Y - <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT - ,.. i ._ <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT ..- ., ,. . <br />REQUIREMENT ~ `~ <br />SAMPLE ~,`~ ii <br />MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT ~r r <br />SAMPLE <br />MEASUREMENT <br />PERMIT - - <br />REQUIREMENT '• <br />~MElfITLE PRINCIPAL EXECUTIVE OFFICER I <erury under penalt. of law Thal Ihic dra"umrnt and all nuarhment+..+-r. <br />i <br />d <br />i <br />d <br />i <br />i <br />d <br />i <br />h <br />d TELEPHONE DATE <br /> under nn direction or wla•r+ <br />an <br />u accur <br />mrce w <br />~ c..lent <br />kne <br />pnq+arr <br />+ <br />t <br />e+ <br /> <br />-- <br />- b. secure Ihul yualificd perv+nnd prn)x•rlc Kallw•r and ec:dualc tlra• information <br />- - <br />- whmitted ttu+ed nn m) ingwn of the 1>.•r+.ar nr prr+nn. who nwna{;c tlx s}+trm. -. <br /> or th~.+r penouc dirccd+ n•+)hmvblr h.r gwhennp thr inlr,rmali+~n, the inrorrrwlinn ~. . -_. <br />' <br />' hmiuad ic <br />u. the tw,l of m. Anowlyd <br />e <br />md Ixdirf <br />trot <br />uu'urarr <br />and <om <br />leta ~ <br />, <br />~ <br />, , <br />g <br />. <br />. <br />, <br />p <br />. <br />m <br />. SIGNATURE OF PRINCIPAL EXECUTIVE ~ - <br /> <br />TYPED OR PRINTED I :+m aware That there ore +ignifnvul prnal[ie+ for cuhmiuine fat+r inrurnwtiotl. <br />indudin. the p+mihilih ..f tint and impri+nnmrnt Por knowme +iolutionc. OFFICER OR AUTHORIZED AGENT AREA <br />DE NUMBER <br />YEAR <br />MQ <br />DAY <br />S AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (flee, 3.'99} Previous edtuors, may be us=d 1 his is lt -3-r,iTl filitll. <br />