Laserfiche WebLink
PERMITTEE NAME ADDRESS ; <br />NAME <br />ADDRESS r-1E <br />FACILITY <br />LOCATION . <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) - ` <br />PERMIT NUMBER DISCHARGE NUMBER T DIAL FdTl;_.AN <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO r <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE } <br /> MEASUREMENT <br /> PERMIT <br />F 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 certify under penalp of lai that this document and all attachments were TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed <br /> to assure that qualified personnel property gather and evaluate the information <br />b <br />i <br />d <br />B <br />i r-^ <br /> su <br />m <br />tte <br />, <br />ased on my <br />nquiry of the person or pawn, who rnanagc the system <br /> or those pers xis directly rcyponsible for gath ring the informatum, the mfomwuon <br /> <br />t <br />th <br />t <br />wl <br />d b <br />f: w <br />d <br />l <br />t <br />b <br />i <br />d <br />t <br />f <br />k <br />d <br />l _ <br /> o <br />my <br />no <br />.c an <br />e <br />e. accurdt.. an <br />comp <br />su <br />m <br />tte <br />is, <br />e <br />s <br />, <br />e <br />ie <br />e <br />e <br />t f <br />i r <br />tp <br />nt r <br />i t , <br />n-,n <br />I <br />th <br />1„r <br />uh <br />r <br />L <br />•n SIGNATURE OF PRINCIPAL EXECUTIVE <br />.. _, ^? <br />- - <br />TYPED CIA PRINTED i <br />. <br />am aware <br />n <br />, <br />,e, <br />> <br />m <br />,c <br />, <br />: <br />• <br />Including the Di e^ tr -cir at..ri OFFICER OR AUTHORIZED AGENT C DE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLAI IUNS (tfererence all attacnments nere) <br />-JR PRECIP. EVENT - SEE I. A. 1, PG 3. FOR F <br />cAnsol T kin Yj%4c:'TCGi if -r Triru= _ T r• 7 on 1A <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ;)0- 4c. This is a ?4-part form.