Laserfiche WebLink
PERMITTEE NAME/ADDRESS (Include Facilo Name/l acntion if Di ferenrl <br />NAME <br />ADDRESS <br />NIA <br />FACILITY _ <br />LOCATION A <br />ADLE'?' E. HANSON <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. 2040.0004 <br />rl? : <br />t St. ,; r; . <br />DEL <br />MW TO '. CIR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <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 _i <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I certify under ptnaln of law tlmt this document and all attachments were <br />ared under ms direction nr su <br />ers Won in accordance with a s <br />stem desi <br />ned <br />re TELEPHONE DATE <br /> p <br />p <br />y <br />p <br />g <br /> to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Rawd on my inquiry of the person or persons who mamrRe the system, <br /> or thorn persons directly respmsihk• for gathering the information, the information <br />- submitted is, to the hint .if my knowledge and Wier. true, "curate. and complete. <br />awar <br />I <br />that the <br />e <br />e <br />i <br />ifica <br />n <br />lti <br />f <br />h <br />t <br />I <br />f <br />ti <br />t <br />itti <br />k SIGNATURE OF PRINCIPAL EXECUTIVE - '' ? <br /> <br />TYPED OR PRINTED am <br />r <br />ar <br />s <br />n <br />Pe <br />a <br />es <br />or su <br />m <br />ng <br />a <br />e <br />n <br />orma <br />on. <br />e <br />gn <br />including the possibility of fine and impriamment for knowing violatirm,. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY <br />(Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. T}i1S'IS a 4-part fonn.