Laserfiche WebLink
PERMITTEE NAME/ADDRESS dnc•lutk Fnrrlin .Yamr-%orution ijDi/Jrnnp NATIQNAL VOLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME r ~ DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS I ~' <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY I MONITORING PERIOD <br />LOCATION - - YEAR MO DAY YEAR MO DAY <br />• ~ - FROM TO <br />,. <br />Form Approved. <br />OMB Na. 2040-0004 <br /> <br />.. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING DUALITY OR CONCENTRATION NO. FREDUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />' SAMPLE ~ ' <br /> MEASUREMENT <br /> PERMIT ,. s l -- <br />s" 'r • :. - REQUIREMENT C'Tr~:~: 1 i'i~ '-- <br /> SAMPLE <br />j~':.:' ", MEASUREMENT <br />- PERMIT , a # - - v <br />_ REQUIREMENT ~ - <br />- SAMPLE ' <br /> MEASUREMENT <br /> PERMIT ~ _ <br />_ <br />-'~;- l i.~;_~'•~ - REQUIREMENT <br />' SAMPLE ' <br /> MEASUREMENT <br />• PERMIT :,. _; ;t ;~.x - , <br /> REQUIREMENT <br />' ~ SAMPLE ~ • <br /> MEASUREMENT <br />,:' PERMIT :.~ r.~ .; - <br />r F ' REQUIREMENT f ' <br />' .!4 SAMPLE <br />-(-HRIJ ~ - ~ MEASUREMENT <br />• ~' PERMIT r -. , . ., . ,.. - -- -' -' ..~ <br />- _ REDUIREMENT C!r11`1 i ? ' <br /> SAMPLE <br />i-~ T ~.~ :_; MEASUREMENT <br /> PERMIT - •~ <br />' REQUIREMENT ~~~ ~ ~ L~ f' , I- ` <br />NAME,fT7TLE PRINCIPAL EXECUTIVE OFFICER I ccntfi under prnglty ut Inw tl~t tlus dncumrnt and all gtLU:hmcnts were TELEPHONE DATE <br /> <br />~ <br />X- pupated under my dirY:tinn or supen•ision in accordance with a system di~stgurd <br />to assure that yualificd persomrl pmpcrly <br />ath~v and c~aluatr the information <br />--'~ <br />. <br />f g ~ ~ ~ <br />"'~ <br /> submmr<I. Based on m}' inquiry of thr pcnon or prrons who rnamge the sy~tettL ~ <br />' ~ <br />., <br />~Y"!' ~ c <br />~= <br />~" <br />- or those prisons dimtl}~ r~pnnsible for gathering the inf'txrttation, the mfommtion ~ <br />' <br /> <br />~~ ~ `- <br />d i <br />th <br />t <br />k <br />l <br />d b <br />li <br />f <br />tru <br />xcwat <br />and com <br />lete <br />b <br />m <br />t <br />b <br />f <br />d <br />; ' - <br />~ <br />~" ``// <br />~" T <br />I <br /> tww <br />gr an <br />e <br />, <br />e, r <br />c. <br />p <br />- <br />su <br />m <br />c <br />s, <br />o <br />e <br />es <br />o <br />my <br />c <br />e <br />I <br />h <br />h <br />it <br />b <br />i <br />( <br />l <br />i <br />( <br />i SIGNATURE OF PRINCIPAL EXECUTIVE ' <br /> <br />TYPED OR PRINTED urmat <br />on. <br />am quare t <br />at t <br />ere ate stgn <br />icant penalties for su <br />m <br />tting <br />a <br />x <br />n <br />includin¢ the possibility of fine and imprisomrxnt for km~w'ing ciolatitms. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANAI IUN Uf ANT VIULAI IVNJ <br />Ref@J <br />,-~R PRF <br />FfJR REOUTREMI=NT! <br />EPA Form 3320-t (Rev. 3/88) Previous editions may t>e used. 301 a ~~ ~ T$IS i3. $ 4-(ldtt fOtT11. <br />