Laserfiche WebLink
PERMfTTEE NAME/ADDRESS(7nd6&FwrlAy)VA-Wi rwif l/D(OW..o <br />NAME <br />ADDRESS .. i I N <br />?. bUA 14JU <br />FACILITY LI-SAD-5 CO <br />nOSIDe NORTH L SCUTH MIN <br />LOS. tK PALISADE CC <br />Lnto r Y -rr.nct, u n <br />Form Approved <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM //NPDES) OMB No 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT tJUMBER DISCHARGE NUMBER J 1,N } <br />FINAL C,ES11 <br />= MONITORING PERIOD 'I D 9: G CC LU b A C C LIVE R <br />YEAR MO DAY YEAR MO DAY _ _ <br />FROM TO <br />1 - NOTE: Read Instruction 6efor o IBting this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />E of <br /> X ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br />` PERMIT > ..l <br /> REQUIREMENT <br /> .,I <br /> <br />` r SAMPLE <br /> MEASUREMENT <br /> <br /> <br />V PERMIT <br />h` r i <br />J <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT _ <br /> !W X <br /> SAMPLE <br /> MEASUREMENT <br /> <br />1 PERMIT J:LTi:rv t <br />r )?i 1CL/ rni_ <br /> REQUIREMENT - <br /> t ? <br />?. <br />' SAMPLE j <br /> MEASUREMENT <br />_ PERMIT ra .?; r r +; +qX«• a'G h l i C.. i <br /> REQUIREMENT <br />« SAMPLE / <br /> MEASUREMENT <br /> <br />y PERMIT ,. i U r <br /> REQUIREMENT <br />L 1 <br />id A <br />L) SAMPLE t <br /> MEASUREMENT <br />_.... <br />/ PERMIT C LEI T = 16 t G <br /> REQUIREMENT <br /> <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER 1 nntly under penally o Is. that this document and all witichmenO were <br />d <br />d <br />l <br />i <br />a <br />TELEPHONE <br />DATE <br /> prepare <br />un <br />er my d <br />r l <br />on or sugar. <br />on in accoedann with a system designed <br /> <br />- ??- to assure that qua fled personnel property gather and es.lusle the Information <br />submitted. Bash on my Inquiry of the person N person who manage the system, <br /> <br />1 <br />1 or those person directly mpordbk for gathering the infonnatioa, the Information ? <br />' submitted ls, to the best of my knowledge and belle(, true, itmunte, and complete- <br />I am .wan that there an sltNncant penal"" for submitdn <br />false Infome adoe <br />SIGNATURE Of ?RINCNAL EXECUTM <br /> t <br />. <br />I <br />f AREA <br />TYPED OR PRINTED ncludlnt the poadWIlly o <br />flee and Imprisonment for knowing rlolaUw OFFICER OR AUTHORiZEO AGENT ODA NUMIKR <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION Ur AMT VIULw I wns fRererenc0 M erc&cnmenr: nee/ <br />EPA Form 3320-1 (Rev. 3/99) Previous edibons may be used. This is 4 4_-pant form. PAGk OF