Laserfiche WebLink
PERMITTEE NAMElADDRESS tfncfldr Facility A'ante/Location if /Affirrnt <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />O FROM TO <br />Form APProvt3d. <br />OMB No. 2040-0004 <br />MINOR <br />( SI.IIIR f"iH i <br />c~ - FINAL <br />MW TQ UNI48D TR I $ TS] HUI <br />NOTE: Read Instructions before completing this form. <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION , OF <br /> <br />EX <br />ANALrsIs TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT - <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT • <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> - - - <br /> PERMIT -: i ~ r <br />... _ <br />- <br /> REQUIREMENT - • • - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify umirr prnulh of law lhal this docum.•nt and •rll auachma•nts were TELEPHONE DATE <br /> prrpurrd undrr my direction or suprrvision is amxilancr aiW a cy stem drsiKnrd <br /> to accurr that qualified prrsonllrl properly Pathrr and esaluate the inf~mmatian <br />IM <br />N <br /> em. <br />sy <br />whmitted. Nosed Im my inquin of the pervm ur perwns who manatyr <br /> rnom directly resplmsiblr for t:atherinK Ihr information. Ihr informntfoo <br />or Iha.r <br /> p <br />t <br />d <br />l <br /> rnmp <br />e. <br />r <br />wbmitted ic. w Ihr hrst rAmy ka~wlydge and 6rlief, trvr. accurate, an SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am awan• thal lhrre arr siRnifirant prnnlties for submillinR fdse informrtiam' <br />FFICER OR AUTHORRED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED inchdinK for IwnsihiHty of fine and impri+onment fur knuwinti; r„,tati~xts. O <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />COMMENTS AND EXPLANATION VF ANT vwLA I wlvs I-•fe-erence an aaacnrnenw nrrC~ <br />.,T•r--^ rc ~F'r,,~!„?'RrD T~ ~f IL"1IT A RF.QUFST FClR A t <br />TI11S IS S 4-pSrt fOitT1. PAGE OF <br />EPA Form 3320.1 (Rev. 3199) Previous tlditions may be uses, <br />