Laserfiche WebLink
PERMITTEE NAME;ADDRESS <br />NAME <br />A. ADDRESS IN I-' <br />fit. ? ? 1 f.4E <br />FACILITY <br />LOCATION CU 8164E <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER FINAL RBLAN <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO /C <br />NOTE: Read Instructions before completing this form. • <br />PARAMETER QUANTITY OR LOADING QUAUTY OR CONCENTRATION NO. FREDUENCY <br />OF SAMpLjE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -, t s of r s _ - - _ . . <br /> REQUIREMENT <br /> SAMPLE <br />?;F: MEASUREMENT <br /> PERMIT x :::,- < + r <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s: ...:,s: # : • r <br />- F F L t_I1' "d T V:' ; REQUIREMENT <br /> SAMPLE + <br /> MEASUREMENT <br />l PERMIT <br />c=FFLIJ=::"•1' REQUIREMENT _'_';:-i=? r1'JG Di- <br />j SAMPLE <br /> MEASUREMENT <br /> PERMIT fi =r##+ .?.; , .y <br />_+1._ ' REQUIREMENT <br /> SAMPLE <br />- MEASUREMENT <br /> PERMIT <br />t'F REQUIREMENT <br /> SAMPLE <br />Di MEASUREMENT <br /> PERMIT REPORT <br /> REQUIREMENT R TR AV ?? <br />NAME/TrrLE PRINCIPAL EXECUTIVE OFFICER I emit) under penalty o1 mw that this do' umcnt and all attachments wcte <br />v TELEPHONE DATE <br />_ i urn to accordance with a system designed <br />prepar:d under my direction or cupen <br />,?,/ / <br />' <br />1 t / <br />SSG to assure that qualified pemmnel properly gather and evaluate the information <br />%. <br />[ submitted. Based on my inquiry of the person or persons who manage the syuem• <br /> or those persons directly responsible for gathering the information, the information <br />r <br />: <br />to the best of m <br />knowledge and belief <br />true <br />accurate <br />and complete <br />submitted is _ <br />C r , . <br />, <br />, <br />. <br />. <br />y <br />t <br />lti <br />itt <br />l <br />i <br />t <br />h <br />i <br />f <br />f <br />b <br />f <br />f <br />I <br />h SIGNATURE OF PRINCIPAL EXECUTIVE <br />/ <br />R PRINTED gni <br />ican <br />se <br />orma <br />ion. <br />am aware t <br />at t <br />ere arc s <br />pena <br />es <br />or su <br />m <br />ing <br />a <br />n <br />f f <br />d i <br />f <br />k <br />l <br />i <br />l <br />d <br />h <br />h OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br />TYPED nowing %w <br />e posd <br />thty o <br />ine an <br />mprisonment <br />or <br />anons <br />nc <br />u <br />ing t CODE <br />GUMMtNIb ANU IzAt'LAIVAIFUN yr AN <br />trrererence au dIIdUfrrrrentZ rrere/ <br />IR PRECIP. EVENT - SEE I. A f, P0. 3. FOR REQUIRE <br />:A:: - <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. _ '+:1 ; TElls is,a 4 -part form.