Laserfiche WebLink
PERMITTEE NAMElADDRESS ,h;~ : udc Focilin• :\'ane:Locmran ijDijfrrentl <br />NAME : ~• ; r~{(^ <br />ADDRESS G R Ft~JO (~ I ~ ~E <br />FACILITY ` <br />LOCATION <br />Mnr.tnr_t"ta <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-000a <br />NnTE: Read Instructions before,comDleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> E:X S TYPE <br /> ANALYSI <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> - <br /> PERMIT -. t`"s;~fti~Tr <br /> REQUIREMENT <br />- SAMPLE <br />,_ _ <br />_ MEASUREMENT <br /> <br />- <br /> <br />PERMIT <br /> <br />` <br />- ..- i* Ki'f-~ ~ <br />- <br />- ^d ' REQUIREMENT - <br />- SAMPLE <br /> MEASUREMENT <br /> PERMIT ^'~ ~ , <br />r~F ' ~ - - REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />' ' PERMIT ~ ~ ~ , <br />_ ' REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t ,; , ,_ t , , ~ A <br />- r ' ~ REQUIREMENT <br />'L SAMPLE - <br />- - - MEASUREMENT <br /> PERMIT <br />' ' REQUIREMENT _ M' i!V T;'i <br /> SAMPLE <br />i t~ MEASUREMENT <br /> PERMIT - <br /> <br />REQUIREMENT _ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I <<rtify ttndcr penalty ~f IuW Ihal this doctmtcnt Bind 311 atlal'hlmCnlS W'efC TELEPHONE DATE <br /> prcpurcd under my direction or sttpervisiom in accordance With a system Acsignzd <br />`; ~~ f /;• ,~^ ,-/ ~ to assure that qualified pet~~nnel properly gather and es-ahmte the information ~ <br />./ - ~"` <br />~ <br />' <br /> sztbmiitcd. l3axd on my ingwry of the perwn or pers~ms who manng<• the s-ystiem, <br />the mformatimn <br />ersons directly respotuible for gathcnng the infutm:nttm <br />ur Uwse l <br />~ <br />G„ <br />~ <br />.~-`` <br />- <br />~ <br />~ ) <br />7' . <br />p <br />li <br />d <br />l <br />t <br />k <br />ld <br />d <br />f ~~" - iU Z- L. ~ ~T <br />!.' ~/ i , tntr, accura4, um <br />comp <br />e <br />e. <br />suhmired ts, to the best ,~f my <br />nuW <br />gc an <br />be <br />e SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br /> I am aware that thzre arz significant pctulres for submitting talsc infurntamrnt' OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED including the pu+sibihty ul fine and impnsnnmcnt litr Lnowing violations. CODE <br />COMMENTS AND EXPLANAtIUN VI• ANT trlvLAlwlva (nererence au aaacnmenrs nere~ <br />~-iR PREC IF. F'JFM1IT ~- ~F'~ I A 2 PG 3. FOF? <br />• c. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. T hiS i5 3 ~-~BTI fonts. <br />OF <br />