Laserfiche WebLink
PERMITTEE NAME/ADDRESS (include FaciUq,1Vew11,orntion ijj)jff nntl <br />NAME <br />ADDRESS li <br />FACILITY <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE 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. 20400004 <br />(SUBR <br />F - F <br />MW TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <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 /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cerof, under lw•nalts of law that this document and all attachmentswere <br />d <br />e TELEPHONE DATE <br /> d under m? direction or supervision in wcordancr with a system deigne <br />prepar <br /> to a %mre that qualified perwnael pruperir gather and rvaluate the information - <br /> suttlied. Based on m) inquiry of the prrw,n or persons who manage the ssslrm, - <br /> or thusr persons dirmth responsible for gathering the information, the information <br /> wbmitted is, to the bast of ms kmwlydge and holier, true. accurate. and complete. SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> I am aware that them are significant Penalties for submitting false informatlaa, OR A <br />THORIZED AGENT <br />FFI AREA <br />TYPED OR PRINTED including the p-ibditi or fine and imprisonment for knowing violations O <br />CER <br />U NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. =, `. This is a 4-part form.