Laserfiche WebLink
PERMITTEE NAME/ADDRESS (/ne6k F.rWgNs.?L. etiaw UD(Qwm i) <br />NAME <br />ADDRESS - <br />. dUA 14JV <br />LiSADt: CC <br />FACILITY U?IDL HURTH b SCUTh :1I <br />LOCATION i. ri P A L I S A V L CC <br />t .'flW -r ?7r n, <br />NATIONAL POLLUTANT OISCHAR0E ELIMINATION SYSTEM NPOES/ <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />J:; FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINCH <br />(S?dR Li) <br />F - F'ILAL <br />fChU 1 IC CCLGkACC b1VEF <br />NOTF• Rose! Instrur+ti- h.t-. ni.rv...iatlnn this tnrm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FRE"IENCr SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX J <br />ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i <br />v <br /> REQUIREMENT . <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />- PERMIT <br />REQUIREMENT <br /> <br />V v <br /> <br />e q <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r. ,:?/?;.: >~4?>1x.• :..t h rGt JL::/ "A - <br /> REQUIREMENT - <br /> r <br /> <br />v SAMPLE <br /> MEASUREMENT <br />l <br /> PERMIT Y. n:*.::c .: ^9Y t <br />c <br /> REQUIREMENT ' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />- PERMIT F G r = r U Ft i <br />i U c A. ... REQUIREMENT 3 Y ?: <br />i A .` SAMPLE <br /> <br />- MEASUREMENT <br /> REQUIREMENT PERMIT <br /> <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 Cen,ty under penalty ° law that thh docvnrrnt and .11 .ttachmemts were <br />TELEPHONE <br />DAT <br /> <br />prepared under my dlrertbn or wprrMslon In .ceord•nce with . system eesaglwd E <br /> to aeum [hot quallned personnel properly gslhef and evaluate the Infornallon <br />submitted. Based on my Inquiry of the person or peromus who manage the system <br /> It <br />di <br />tl <br />ible f <br /> or <br />wr pease s <br />rec <br />y respons <br />or gathering the Information. the Information <br /> submitted bt, to the best of my kno eiecite and bellef, true, .rrurate. and complete. <br /> 1 •m - rs, that there are slgdncant penalties for wbmrtnng false Information. SIGNATURE OF PRINCI?AL EXECUTIVE - <br />TYPED OR PRINTED Including the possibility of nne and Imprisonment for knowing vlolatlom. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />%.VIYIMLI\ IQ AMU Gnr ?nnn t was v. n... .....r r-...vrsv rn wr wr se-w am wu.c.nrrrwRtJ rr Fr Os <br />• r . .. , L t. " I':.. C 1 Y • .. 1? (_ i v ?. 1. L::I r tl .? .. - ^ I. 1. _ .. P i { i f? G <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-Part form. PAGE OF