Laserfiche WebLink
PERMITTEE NAME/ADDRESS flnclade Foriliq .venrc//,oration ljUi/jeretul <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />t~n+rvi3n i-I~ ~>~ TIC <br />~* !VO AISCHARGF 1 ~c i ir'.t•~ <br /> NOTE: Read Instru ctions befo re co mpleting thi s form. <br />PARAMETER QUAN TITY OR LOADING QUALITY OR CON CENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT t. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT .- . <br /> REQUIREMENT <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 />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER 1 eertif~ under pemdty of law that thb ducutrw~m and all aUachmenta were <br />prepared uralrr my dirn4iat ur wprrriam in acrnrdance with a nvtms dedgtted TELEPHONE DATE <br />to xaw•r that qualltled prromsrf pnsperly <br />atbrr and ev <br />l <br />tl <br /> g <br />a <br />uate <br />tr infarmatian <br />whmtttrd. FSuxd sat m~ inyuin of thr prrwn or prrw~m w ho managr the vyctem. <br />or those penan. dir <br />tl <br />JW <br /> n <br />r rcvpm <br />r fur gathering thr infarmattan, the infarmatlon <br />vuhmiUvd i~ <br />to thr hrct of mr Am~wlyd <br />d h <br />l <br /> , <br />ge an <br />e <br />kf, true. arrurate, and romph4e. <br />I <br /> <br />TYPED OR PRINTED am awarr that thrrr are vignifirnnnt penaltis+ for vuhmitting fal+r iniormatlan. <br />includinK thr p.ncihilit <br />of fin <br />a <br />d I <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL y <br />r <br />n <br />mpr <br />annsrnt for Anawing visdaUuac <br />ATIONS (Reference all attachments here) OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />OD <br />YEAR <br />MO ' <br />DAY <br />Gi~A~;l_y RpTEIVTTAL AIJt4LV~?IS. <br />. F=•,-~, "s:SZv-1 iR2v _ .,~ ~"evrus ed~Uprts m;ny C~_ USed <br />