Laserfiche WebLink
PERMITTEE NAME/ADDRESS tinclude Facility N'amegacation if Lhyferentl <br />NAME -1 C <br />ADDRESS <br />FUX 628 <br />FACILITY <br />LOCATION 42L <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />N 1 NOR OMB No. 2440-0004 <br />(SUDR MH) <br />F -- F 1NAL MNTR5 <br />5R&MI NE DRNG T R I E TO T UT T LE DR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i .. . <br /> REQUIREMENT <br /> SAMPLE <br />- MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i h 2!=ID A A',? ? f ' i1 r \r .' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT x a <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. ?, . :... <br /> REQUIREMENT DA I LY <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r 79 <br /> REQUIREMENT - I- A T. LY M <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertif> under penult. of law that this document and all otathmmts Mrrr <br />e <br />directio <br />visio <br />o <br />red <br />d <br />o <br />s <br />e <br />i <br />d <br />with <br />st <br />d <br />si <br />ed TELEPHONE DATE <br /> pr <br />pa <br />un <br />er my <br />n <br />r <br />up <br />r <br />n <br />n acc <br />r <br />ance <br />a sy <br />em <br />e <br />gn -- - <br /> w assure that qualified persanmrl proprrf'v gather and rvaluatr the information <br /> submitted. Rased on m% inquire to the Person or person Mho manage the -lem. <br /> <br />1 or there Persons directil responsibir I" gathering the information. the information - - <br />} t i, •, %. , _ - suhmitted b. to the In-A of my knonledue and belief. Irue. a xttrate. and complete. r - <br />r <br /> m aw <br />si <br />nirk <br />b <br />lse i <br />tio <br />I <br />r <br />th <br />t th <br />nt <br />n <br />lties fo <br />itti <br />f <br />fo SIGNATURE OF PRINCIPAL EXECUTIVE - <br />TYPED OR PRINTEb a <br />a <br />e <br />a <br />ere are <br />g <br />a <br />Pe <br />a <br />r su <br />m <br />ng <br />a <br />n <br />rma <br />n, <br />Including the w* m ibiht? of fine and impri-ment for kni-ing vinlatlons. OFFICER OR AUTHORIZED AGENT A <br /> <br />REA NUMBER <br />CODE <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />(:UMMLNIJ AMU tA 1'LAr4A I IVN UP- AnT VIVLAIIVrvJ Irreverence an arracnmenrs nerel <br />'R/24HR P'RECIP EVENT - SEE I <br />EPA Form 3320-1 (Rev. 3,199) Previous editions may be used. - "775 -}S 'a 4-Part f6rm.