Laserfiche WebLink
PERMITTEE NAME/ADDRESS ilnclude Facility Nameilrration if l)i fe"wi <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <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 />F - FINAL Roul <br />D5CHG TO KOLL DITCH#3/TR0LJT CH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br />`1' <br />t t <br />T 'l <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />`? ? <br />I''?S <br /> MEASUREMENT = _.? C'• <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT %. <br /> PERMIT <br />R. Ef <br /> REQUIREMENT DAILY `' - <br /> SAMPLE <br /> MEASUREMENT <br />;f <br />??CJ <br />V <br /> PERMIT - .. , 1 <br /> REQUIREMENT ?':' ; 1 : a •; ; <br /> SAMPLE <br /> MEASUREMENT `t b- I 1 I -1 S- <br /> PERMIT - , <br />. . <br />IN <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> MIT a , [ % <br />. <br /> EMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certif% under penally of Iaw that lhiy d-iment and all altaahmenls were <br />li <br />lo <br />d <br />d <br />di <br />i <br />d r <br />' TELEPHONE DATE <br /> <br /> <br />q prepare <br />un <br />er m% <br />m <br />n accor <br />on or wl- <br />on <br />ance with a system designed <br />toure lhatn <br />pcr.annel prnperiy gather and evaltiate the <br />d <br />t <br />n <br />it <br />f <br />s <br />b <br />itt <br />d <br />d <br />H <br />d <br />i <br />i <br />h <br />-- <br />-- <br />r <br /> s <br />in <br />the <br />aw <br />a on m? <br />n o <br />e 1-n or peRanc who hp manage ge the Y\'FLem. <br />u <br />m <br />e <br />. <br />e <br />. <br />w <br />nyu <br />t ? <br /> or Ili- per?nn, dimtly respmyiMr for gathering the informati.m, the information <br /> suhmitted is• to the best of m% km-ledge and belief. Intr. accurate, and rompktr. <br />I am aware that there are mitnifkant <br />eaallies f tt whmiltin <br />ralw i <br />rorm <br />ti4 <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED p <br />g <br />n <br />a <br />m, <br />im•luding the ptniibility of rme and Impriumment fur knowing yiulatiom. OFFICER OR AUTHORIZED AGENT COD NUMBER YEAR MO DAY <br /> <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. 00 1 9 S,1' Cf)t hi% is a 4-¢1rt form.