Laserfiche WebLink
PERMITTEE NAMElADDRESS Uncludr Fxilin :\'amdlnratian iJDifJrrenfl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT pISCHARGE 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. 2040-0004 <br />J ~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION (~Q, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> pNALrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERM-T <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TRLE PRINCIPAL EXECUTIVE OFFICER I certir> under penalty or law thin thi+d•K~mrnc and nll attwhnnm+w~rc ~ TELEPHONE DATE <br />prcpored under my dirntion or supen isl,m in accurttance with n sy+tem dcslRned <br />lu n++ure that ywli0ed pervmm•1 properly Kathrr and c. aluate the iararmstitm <br />+uhmitted. Bn+ed on my iayuln „f the prr+un nr prnnm who monage the ar:+trm• <br />ar thu+e per+utt.directly responsible for gatherinK the infurmatinn, the Infurmntion <br />- whmittad b, to the Aest of m+ Lm,wlydRr and I+rlirf. true, accurate, and rumpkte. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am aware that there arc +ignirrcant prnaltic roe submittinK rake infot•madon• <br />M <br />r <br />k <br />i <br />Wth <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED , <br />im•haling 1M• p.xsihility of fine and impel unment <br />oe <br />tu,w <br />nK s <br />xu~ <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />' ANP <br />. a - - _' •. ... ~.~. .. ...~..• ........~ ...•..• v ~ .r•~ + rsl1-~ A"1' 1 .1l' L rr.. J fa'T G I'7I7:>•7 'i fl ilN1N <br />Thisys a 4-part forn1. <br />