Laserfiche WebLink
PERMITTEE NAME/ADDRESS QncMde radWy N'ame/Lora6an if &fftrent) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (OMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY i rN f i1 +C ;?I.1?1^ ` YEAR MO DAY YEAR MO DAY <br />LOCATION DEN C FROM TO <br />Y K.ARn, RECI AMATfON MANAGF- <br />w <br />Form Ap ved. r <br />OMB No"940.0004 <br />F - <br />U5G <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT i _ <br /> PERMIT r <br /> REQUIREMENT L . - <br /> SAMPLE <br /> MEASUREMENT = -? - - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT j? <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />A <br />R <br />M <br /> ME <br />SU <br />E <br />ENT _ <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 1 crrtity under penahy orfu.. that IN, dwisment and .11.1w, hment, -re <br />d <br />d <br />di <br />ti <br />i <br />i <br />I <br />d <br />i / TELEPHONE DATE <br /> Prepare <br />un <br />er nit <br />on or upert <br />on <br />rec <br />. <br />n amor <br />unce w <br />th a ...tcm detipned <br /> to awwre Iha1 qualified Per..mnel properly gather and e.aluate the Information ' <br /> .uhmitted. Bawd on my inquiry td the pen:m or penon% who manage the -tent, <br /> or 11ti, perams dir fls nxPtm.ihlc for gathering the information- the inrormation <br /> .utrrnuied i., ht the 1-1 4 my Anuwleder and trued, inw. arrurute. and compkte. J <br /> I am aware that 1M rr ..re .ienifia,un txnalne. lru ...twmne falw• information SIGNAT E OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED . <br />induding the j-,ihdil f n- :uwt hnpn...nmont hu An wore .iolation , OFF( R OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />VVMMtN I S ANU tAYLAIYA I IUN Vr AN r vIVLA 11Urva (Preference aft aaacnmenrs nerej <br />?E <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. rhis is a 4-part-form. PAGE OF