Laserfiche WebLink
PERMITTEE NAME,'ADDRESS tlnclude Fitcilin• Nrrme:Lacarinn ijDijJenna NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />Form Approved. <br />OMB No. 20440004 <br />t tJAI ~ [iL.r1N <br />D Tl~ SCUL.IrT-~N GL <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY i <br />Of SAMPLE <br /> ~ TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />'• SAMPLE <br /> <br />r>`. r '' -- :± .- ~ c '- <br />MEASUREMENT <br />r~ - UC_• / <br />U. CJU l <br />G' <br />/• ~ <br />(9 n. ~~ <br />' PERMIT ~ ~~ <br />- <br />~ <br />Tr +. <br />F- ~ L `_'; "•, REQUIREMENT ~ `; - <br /> SAMPLE <br />Tu ~ ' ' -~ MEASUREMENT C_, <br />'~ PERMIT •ts• ..~.. >~ <br />1:.Fi L'Jf~`P: ` REQUIREMENT - '-'` '•'•- y ' <br /> SAMPLE <br />.'? _ ,- MEASUREMENT ~ ~ U, / '~ !- ~ ~ <br /> PERMIT ~ • - ~ ~ ~ -; ~. <br />- _ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME1TiTLE PRINCIPAL EXECUTIVE OFFICER I :cniCy under pcnalry of law that this dcKruncnt and all auachmrnts wcr TELEPHONE DATE <br /> prepared urnicr my dtrcctiun or supcrs•ision in ace+mlance with a sy3tcm dr~igncd <br /> to assure that yualiticd prrsonnel properly gather and c+•oltrate [hc infonnanon <br /> submittal. Nased on my inquiry of ttx person ur persons a ho manage the .rystcm. <br /> the mfimnatioo <br />or those persons directh• mtwnsible for gathering the infermahon <br /> , <br />submitted is. to the I+cst of my knowledge and bcliet: true, accuram. and cnmp!~KC. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I ttm aw:ve that there are si~mrticuut penalties for suhmitting Cake mtbtmanon' QFFICER OR AUTHORIZED AGENT AAEA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED indudir.g the pus~thilih~ of firn- and imprisonment for knowing +iolavuns- CODE <br />COMMtN I5 ANU txru~nr+t tun ur Hrvr vtuvat wtva Inererenca arr auaenrnesnta uvre~ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. •`~ i.> 00 ~% Tli'is {s a 41part form. <br />