Laserfiche WebLink
PERMITTEE NAMEIADDRESS ilncludr F"&ly J -me1Lorari m if l)i fount) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />,'F [..E•-NCH, SR E,.4\ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO F- I d <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUER <br />F - FI <br />DSCFiG <br />NOTE: Read Instructions before comoletina this form- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />T <br />^ <br /> MEASUREMENT ? `•i ! : <br />j <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/TITLE PRINCIPAL EXECUTIVE OFFICER I ,'enir% under ia•nahy orlaw that this do cumrnt and all attachments were <br />d <br />d <br />di <br />'? <br />- TELEPHONE DATE <br /> prepare <br />un <br />er ml <br />rrrtinn or supenisiom in accurdanee with a sy slem deigned <br />i ? <br />- <br />- <br />7?..?.. Qf `? :•` t,- as.ure that qual <br />fied pen,mna9 prulx rlt author and r. olunlr the infurnmtMm <br />suhmill d. Ilased on my inquiry of the prr%un or pervms who nonage the syslem. " <br /> or those penow/a direrth respomsibk for gathering [be information, the information - <br /> <br />T submitted is, to the beat ,d my kro-lydgc and holier. true, accurate, and complete. lw Lj !/ <br />• ?j i? ' <br /> I am aware that there art si <br />nifka/u <br />enulties for <br />b <br />itim <br />f <br />ls <br />, i <br />fo <br />tio SIGNATURE OF PRINCIPAL EXECUTIVE . <br />. <br />v <br />TYPED OR PRINTED g <br />p <br />u <br />m <br />a <br />a <br />n <br />rma <br />n, <br />e <br />ncluding the possibililt of fine and impri-nment for knowing SMlalloms. OFFICER OR AUTHORIZED AGENT AODE NUMBER YEAR MO DAY <br />vvmmLl.?J MnV Lnr -...,,v,. - e+,., .wo_allvl.J Irl GIG1 E'I ra.O on al[aW rnlrrllz I/C/Cl <br />EPA Form 3320-1 (Rev. 3/") Previous editions may be used. DO 1 96 This is a 4-(tart-form.