Laserfiche WebLink
PERMIT TEE NAME ADDRESS <br />NAME <br />ADDRESS <br />'+Li Gh <br />FACILITY l4L .. <br />LOCATION t:, i? 1 b <br />i I 144 r). J4 r. sF NIANAL:F'R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER F I P.IAL PSL_AN <br />MONITORING PERIOD ED WASH <br />YEAR MO DAY YEAR MO DAY ,/ <br />FROM TO h <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE = <br /> MEASUREMENT <br /> PERMIT <br />F7 <br /> REQUIREMENT i, <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of tau that this document and 411 attachment% N'CTC TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed - <br />r ?y <br />fGir? ?+' M s S to assure that qualified personnel property gather and evaluate the information <br />th <br />b <br />in <br />d <br />B <br />d <br />i <br />f th <br />h <br />t .rte' y <br /> e person or peresms w <br />o manage <br />;u <br />m <br />e <br />. <br />au <br />on my inqu <br />ry o <br />e s <br />em _- <br /> or chow persons directly responsible for gathering the information, the information <br /> <br />` submined is, to the best of my knoulcdgc and belief: into, a•zvratc, and complete <br />n <br />h <br />h SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED PRINTED ; <br />n a.:u at t <br />ere are i m t .c:, <br />r <br />mi m r t : •r <br />the e <br />:ib <br />hn of fin OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> ,„ <br />po. <br />t <br />e CODE <br />COMMENTS AND EXPLANATION OF ANY VIULATIUN5 (Hererence an artacnments nere) <br />IR PREC IP. EVERIT - SEE 1. A. 1, PG. 3. FOR REGU I RFMENTS. <br />SAMPLING INSTRUCTIONS - I. C. 7. , PG. 14. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. C) 2 « This 1S-S-4.pprt form.