Laserfiche WebLink
PERMITTEE NAMEiADDRESS ~lncltdo Fan!!h• ~~iimr.Q,ocarran rJDif/errnq <br />NAME <br />ADDRESS - ~ .l "~'= <br />i_ .. <br />FACILITY <br />LOCATION; .._ ; <br />t;~ 31681 <br />tr_ w~.~wtn nCt~ <br />NATIONAL POLLLRANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBEfl <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Folm Approved. <br />OMB No. 2040-0004 <br />it L At(1 <br />,' <br />NOTE: Read Instructions before completing this form. <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> EX YSIS <br />N TYPE <br /> A <br />AL <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />• ~ SAMPLE <br />i '; , MEASUREMENT <br /> <br /> PERMIT ~ ~• <br />~., <br /> REQUIREMENT <br /> SAMPLE <br />'j; MEASUREMENT <br /> PERMIT "' • <br /> <br />= F :~ '_ REQUIREMENT <br /> SAMPLE <br />Fi <br />~ MEASUREMENT <br />. <br />., PERMIT _ <br />r REQUIREMENT <br />, SAMPLE <br />~ <br />j ~:;• <br />, MEASUREMENT <br />. <br />, <br />_ <br />• _ <br />•' <br />! PERMIT <br />~~= c- REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />E PRINCIPAL EXECUTIVE OFFICER <br />NAME/TITL I ecrtil} under prnulq~ of law that this d+xwncm and all attnthmtnts u•err TELEPHONE DATE <br />. • dimuon or sups-n~i+ioa in acuxdance H•rth a svotem designed <br />d <br />nd <br />r m <br />~ <br />~ <br />~ ~ <br />'r` ! <br />"' pr <br />u <br />e <br />} <br />purc <br />«+ assort thnt qualified pencmnrl properly ga[her end cvnlmte thr infom+etion <br />ns wlw tnana <br />c the system <br />r <br />f U <br />d <br />i _ . <br />'7"-'-'-'-~- <br />+~ - ~-- - - <br />- ~_ ~: <br />~- +c I+rrson ur pe <br />g <br />, <br />oo my inqu <br />ry o <br />so <br />submined. Bese <br />the inGmnation <br />the in('unnaticm <br />atherin <br />l <br />ibl <br />C <br />h <br />di - <br />'"~'*~ - <br /> , <br />y respons <br />or g <br />g <br />ose {xxrsons <br />rect <br />e <br />nr t <br />~ '/ <br />•~ <br />~ <br />e'er ~ submincd is, to the bear o(my ktroscledgc and belief, true, nccuratc, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE - ai <br />~ ~= G'. ~ 1L / 7 <br />, <br />i/ I am aw:ur that thtre ars significant pcnalucs for subn+nting false mfonnatton• QFFIGER OR AUTHORIZED AGENT A EA <br />DA <br />TYPED OR PRINTED including thr posstbiliry of tine and impnwnmrnt for knowin, siotations CODE NUMBER YEAR MO Y i <br />COMMtN 1, ANU t7CYtJ41VAt lvt+1 yr n+~ r vwv+r <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />JCTIONS - I. C. 7, PG. 14 <br />PkGc '~~ <br />111~~ l~ :1 •~-~~~1C[ i 1:~ ' <br />