Laserfiche WebLink
f'ERM(TTEf NAME/ADORESS(!w^i~4f«+MgN~[.orrron yD~Qbwr) <br />NAME <br />ADDRESS _iA' ..~„... s <br />:. ~KER Cf BY~42 <br />FAC1lfTY <br />LOCATION "`"`"f~(EfZ ~'~-~ 131x41 <br />NATIONAL FOILVTANT OtSCHAROE ELIMINATION SY9TEM /NP~IESJ <br />DISCHARGE MONITORING REPORT tO Rl <br />PERMIT NUMBER ascNAROE NuMeER <br />MONITORING PERIOD <br />YEAR MO D Y YEAR MO DAY: <br />FROM TO <br />Form Approved. <br />~~ I NOR OMB No 2040.000a <br />C SUER ~JC <br />F - rlp.lAi- <br />'30~SARn PC-t~I} TQ WILSt:~N uR <br />NOTE: Read kwtrucdo~e before cort+pletinp this fwtn. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION n1O, <br /> <br />EX FREQUENCY <br />of SAMPLE <br /> <br />TYPE <br /> ANALrsIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE . ~ ~ , r7 ~f ~' _- '~~ - <br /> MEASUREMENT <br /> <br />:,'~ _ : REQUIREMENT t`1 I N ~ t^.UM ~.' <br /> - <br />_ SAMPLE :.: <br />~ % C~ ..- .}„Ci '; <br />' ~' MEASUREMENT "~" <br /> <br /> <br /> PERMIT , , . ~~ r\ I ! '~ i^ k •' 13i ~- <br /> REQUIREMENT , <br /> <br /> SAMPLE -- ~ -- _. ._ - ~ -- _ =. %, <br /> MEASUREMENT <br />l,. - <br />~, ~~- <br />. <br />;~_;.;•. 'r'~L - PERMIT -?(?[i~ %aV:.> DA I l_ ~' !°iX !'"IL , <br /> REOUIREMENT <br />.,.. _ <br />, <br /> <br />-. _ . _. VF"; • (.: SAMPLE '' . ~ l ~ <br />-_ r %~ f; <br />: / . _ <br />~' ~/ _°- <br />~-,-~ :~~%.',! *,. <br />1 ~ MEASUREMENT ., - <br /> ' <br />_VEPJ 1 ^"~7=:=: ~ <br />- PERMIT ;.:• :_3;1~P. .•.,.,~: I)„ ; _ , ;.~ i L1r~ <br />~- <br />~ ; ~ _ r REQUIREMENT <br /> SAMPLE ~.~/~~ ~ ~ - _~ ,.~'a' _~ <br /> MEASUREMENT ~ _ <br />~._l1LN i~ :~~, PERMIT <br />REQUIREMENT I~px ;L-;, ;. <br />t <br />~ ~ t. s~• SAMPLE <br />- ~ <br />~ - <br />~ <br />~ _ ;j• i;'~ <br />-,L~ 1 Q MEASUREMENT ~-~~i~~ = .~±.y-}: `- ~a ~. <br /> <br />-. ?J- `~= ~ , _ - PERMIT <br />' <br />}' <br />- . ~i~ ~;; t-~r.;~ <br /> REOUIREMEN <br />C <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' "n'ry r r pen^ ty o 4. th^t tFh document ^nd ^q ^tt^chmmU .ere r <br />TELEPHONE <br />d <br />tt <br />hl <br />I <br />d <br />J <br />l <br />DATE <br />prep^re <br />un <br />on or tup.n <br />en <br />er m~ d <br />rec <br />n ^ccoM^nn rltA ^>>f <br />em da~~nM "//] <br />10 tNA1R to^1'r.llrlfd perfenllel ~Ieperl~ ~^IAer ^nd f~^lu^le IAf Inrerm^tlon ~ / ~ / <br />~~ <br />__ <br />~~- i ; !t ~r `% ~ ~ ^remttted. ese on m~ tnyrlrt of u.e pervert or per~oro .Ao nrn.~e tAe tyttem, - ' ~' ' <br />i <br />- <br />_ f., fiI <br />- <br />, <br />~ ~ or IAo^r per^oro dlrac7l~ re^porMAle for ~^tAMrK IM Inform^llon, the Inferm^llon i/ 1 ^ ~ 7 / <br />"_ ~ ._" % + f f :~ L _ L ice.- auAmltled b. to the Ant o! m~ knewkd~e ^nd lttMef. true. ^ccvnle. ^nd mmykle. / 7 ~ ~1 ~ ~l .~ 1 <br />tiIONATURE OF -RINCt-Al EXECUTIVE ~ <br />C. ' ~ ~' - 1 <br />m <br />r <br />tA^t tl <br />r <br />N <br />Nn <br />t <br />rtl <br />ter <br />ut•mltn <br />6b <br />Int <br />t <br />~. ~ ~ - ~~ ... <br />' ~! <br /> ^ <br />^.^ <br />e <br />ure ^ <br />e <br />E <br />on <br />pen <br />n <br />t <br />rK <br />e <br />orm^t <br />on, A A <br /> <br />TYPED OR PRINTED Indrdln tAe Drat etnnr ^nd t A^onment ror Ano.in lo+^Uoni <br />~ p°'r y '"p ~ `' OFFICER OR AUTNORI2ED AOEN1 NVMBfR <br />CODE YEAR MO OAY <br />~:GMMENT$ AND EXPLANA7lON OF ANY;VIOL~LTlONS (R~/er~nc• ~I'ettacAm~nls/+dvd i~ PRECIP EVL iV T IS CLAIt"iED. IF CLAIM APPRCV~D L;Y W{xGL~• <br />_ ~ ;r-f4ENT~; - SEE I. A. ~_. PC3. 3 €GP ~"^~'.~.~• - - ~:~~r: <br />- i _ _ ^'_~rti" 1.r~IST?tJC't'IO€4 - I. _. .. 3. ~.- <br />- - '°._ ~ : , ~ • ~ - - PAGE of <br />ref Form 3320-1 IRev 3/99) Previous edlvons may be used - "' tS 15:X'4-part36ttn. <br />