Laserfiche WebLink
PERMITTEE NAME/ADDRESS tlnelade FaeiGf) Na clLocanon if &fferenn NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS - I•: r <br />BO x :,7 -y PERMIT NUMBER DISCHARGE NUMBER <br />DEN MONITORING PERIOD <br />FACILITY tOf'' L` YEAR MO DAY YEAR MO DAY <br />LOCATION DEN FROM TO <br />Y KARO, RECLAMA <br />Form Approved. <br />OMB No. x040-0004• <br />MINOR <br />SUB F? i ;I- <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX OF <br />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/TITLEPRINCIPAL EXECUTIVE OFFICER 1, 1td'sunder penaltyoftawthat this document andallattachment%were <br />ared under m <br />n or su <br />rvision in <br />ccordanc <br />with a +sstem desi <br />re <br />directi <br />ned TELEPHONE DATE <br /> p <br />pe <br />g <br />p <br />y <br />o <br />a <br />e <br /> to assure that quaiiried personnel prwprris gather and evaluate the information <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br />i <br /> or iho+r penun+ directly mpnn+iblr for gathering the information. the information <br /> submitted is, to the best of my knowledge and belief. true. accurate, and complete <br />w <br />I <br />th <br />t th <br />i <br />ifi <br />lti <br />b <br />itti <br />t <br />f <br />f <br />l <br />i <br />f <br />ti SIGNATURE F PRINCIPAL EXECUTIVE - ' _ <br /> <br />TYPED OR PRINTED am a <br />are <br />a <br />ere are s <br />gn <br />can <br />pena <br />es <br />or su <br />m <br />ng <br />a <br />se <br />orma <br />on. <br />n <br />including the possiblity of fine and impriummml for knowing violations OFFICE OR AUTHORIZED AGENT AREA <br />D NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPL.ANAt IUN Utt ANY VIULAIIUNS (Nererence all arfacnmentS nerej <br />EPA Form 3320-1 (Rev. 399) Previous editions may be used. - - - - -- - This is a 4-part form. PAGE OF