Laserfiche WebLink
PERMITTEE NAME/ADDRESS'include F"dift• Namr/tixaean if AfjereaU NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />(-tl?+L COMPLEX YEAR MO DAY YEAR MO DAY <br />LOCATION EN ! ; I, 81i FROM TO <br />Y kARrl. PFCL-AMATrON MANAGE <br />Form Approved. <br />OMB NJ j I40-0004 <br />MINOR <br />(SUER JC ) <br />F -- FINAL <br />DSCHG TO TRI <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 /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> i <br />I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT I <br /> SAMPLE <br /> MEASUREMENT - <br /> PERMIT t. rt , <br /> REQUIREMENT <br /> SAMPLE L y ? <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif. under penolh of law th,it thn d-ument and all atmchmems were <br />re <br />ared under m <br />dimctwn or u <br />criision in accordance with u s <br />stem dosi <br />ned TELEPHONE DATE <br /> p <br />p <br />y <br />p <br />y <br />g <br /> to assurr that qualified p-nnel properly lather and esaluate the in(ormathm <br /> suhmithrd. Rased on my inquiry or the person or perams whn manage the 5y9em. <br /> or throe persons directly m,f onsiMe for gathering 1M• information, the information i <br /> submitted is, to the hest of my knowledge and helirf. true. accurate, and complete. <br />s fo <br />I a <br />aw <br />rr th <br />t the <br />e si <br />mrk- <br />en <br />lti <br />hmittin <br />k <br />I <br />fo <br />atio <br />l <br />f $IGNA RE OF PRINCIPAL EXECUTIVE l f \ <br /> <br /> <br /> <br />YPED OR PRINTED m <br />a <br />a <br />re ar <br />m <br />a <br />r su <br />g <br />e <br />n <br />p <br />e <br />rm <br />n, <br />g <br />a <br />including the pussihdiq of fine and impreonmenl for knowing siolations. <br />P <br /> <br />OFF ER OR AUTHORIZED AGENT <br /> <br />AREA <br />CODE NUMBER <br /> <br /> <br />EAR <br /> <br /> <br />O <br /> <br /> <br />AY <br />COMMENTS AND EXPLANAIIUN Ut ANY VIULAIIUNS (mererence all atfacnments nere) <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. 00029 ' `'This !'b a 4-part-fdrm.