Laserfiche WebLink
PERMITTEE NAME/ADDRESS nae+rdr FordlyHenoWLacrsen t(D16rwr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI <br />NAME DISCHARGE MONITORING REPORT /D RI <br />ADDRESS <br />P. O. BOX i ` • PERMIT NUMBER DISCHARGE NUMBER <br />PPER M I i-4:= MONITORING PERIOD <br />FACILITY YEAR MO D YEAR D Y <br />LOCATION I G C 0 8- FROM TO <br />YMOND G. DU BOIS, PRES/GM <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL MOFAT <br />ACUTE WET TESTING FOR 011A <br />NOTE: Read kwtructione before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />P H; MEASUREMENT <br /> PERMIT "I . , IF* <br />i UU() I AS <br /> REQUIREMENT _ NN VALUE <br />- <br />S SAMPLE <br /> MEASUREMENT <br />.'J6C - `- - PERMIT sr ;,-:. .;, z a Al -?l <br />.? - :I .? r .-. (A E. <br />F LUEN r GR05S `,. REQUIREMENT MN VALUL <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 t certlly under penalty ° .. that thh dorumeni end all attachments were TELEPHONE <br />prepared under my direction or supervision In aRordare with a system designed DATE <br />to assure that qualified personnel properly gather and evehrate the Information <br />/ oubodtted. award oe my Inquiry of the person or personr who m.nate the system, <br />ctl <br />ible f <br />th <br />i <br />th <br />I <br />t <br />r <br />the I <br />th <br />di <br />ti <br />f <br />ti <br /> <br />- <br />ose pears <br />y respons <br />or ga <br />er <br />ng <br />e <br />n <br />me <br />on, <br />n <br />orma <br />on 7 / <br />or <br />re <br />o <br />k <br />wl <br />d I <br />h <br />b <br />t <br />f <br />d <br />d b <br />W <br />t <br />t <br />d 7 ? ? / <br />my <br />no <br />e <br />submitte <br />s, to t <br />e <br />es <br />o <br />ge an <br />e <br />. <br />rue. arcure <br />e. an <br />complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />l . <br />i I am aware that there are s <br />gnlfirast penroes for submitting faew Informad", AREA <br />TYPED OR PRINTED InNrding the possibility of fine and Imprisonment for knowing vtelatlora, OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Or ANY VIOLA I suns friararence an orracrnmenrs nere/ <br />E. REPORT LCSO - STATISTICAL PIONT ESTIMATE WHICH IS <br />z r t}EPC` -'RM TC' OT <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. J2 `_ T--At?$ g:4-Pgt;fgrm. PAGE lOF I