Laserfiche WebLink
PERMITTEE NAME/ADDRESS (Include Faciluv.vamell ocstion if mffenno <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION r., <br />Aknl t=''i U, N4kIki^r1N <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />t'r•? <br />Form Approved. <br />OMB No. 2040-0004 <br />Cl I I'a:?F'. <br />( SUDR <br />F I r. L-E L- <br />MW 'TO `SEEK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br /> <br />OF <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ?. !a <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> rOUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify tmdrr penalty xi- that thb document and all attachments wen TELEPHONE DATE <br /> :)mpand under my direction or wpervision in acnordunce with a %yo m deigned <br /> to assure that qualified pr-nm•i properly gather and evaluate the information <br />of th <br />rvm who mana <br />e the % <br />mrm <br />itt <br />d a <br />' in <br />i <br />so <br />o <br />h <br />d <br />R <br /> r pe <br />g <br />i <br />- <br />m <br />. <br />ase <br />n ms <br />yu <br />n <br />e per <br />n <br />w <br />e <br /> or them per. ut, directh reiamsible for gathering the information, the information <br /> wbmitted i+. to the It" of m.% knowledge and hriief. true, accuralr, and eomplelr. SIGNATURE OF PRINCIPAL EXECUTIVE <br />/ <br />TYPED OR PRINTED I am aware that then an signir"nt penaltie, ror wbmiuing ra6e information. <br />including the iwMsibility or fine and imprivonmrtn for knowing violations OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />This'is a 4-part form.