Laserfiche WebLink
PERMITTEE NAMEIADDRESS dricfu le Faddy Fame/location if LhWerentl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />0x PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY A MI°1E C-01-3°L_1=X MONITORING PERIOD <br />LOCATION BEN Ct? g 1 FROM YEAR MO DAY TO YEAR MO DAY <br />r KARO, RECLAMATION MANAGE <br />Form App[oved. <br />* <br />OMB No 2040-0004 <br />M I NCJR <br />(SUBR JC ) <br />F - FINAL RUU <br />DSCHO TO TRTB/FI5H CREEK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE / <br /> MEASUREMENT -J ` - <br /> PERMIT <br /> REQUIREMENT r <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 />NAMETITLE PRINCIPAL EXECUTIVE OFFICER I cerlirc under penalty orIs% that this document and all attachments wen <br />ared under my direction or su <br />ervision in accordance with u s <br />stem designed <br />re TELEPHONE DATE <br /> p <br />y <br />p <br />p <br />to assure that qualified personnel property gather and evaluate the information <br />submitted. Based on my Inquiry of the person or person who manage the system, , <br /> <br />- <br /> or those penons directly responsible for itatherins the Information, the Information <br /> submitted h, to the best of m% knowledge and belief, true, accurate, and complete. <br />I <br />w <br />th <br />t th <br />if <br />t <br />f <br />s <br />b <br />itti <br />r <br />i <br />f <br />r <br />ti <br />I <br />l <br />i <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED am a <br />are <br />ere are % <br />Srt <br />pena <br />or <br />u <br />a <br />se <br />o <br />ma <br />on, <br />a <br />can <br />t <br />es <br />m <br />n <br />ng <br />including the possibilfty of fine and imprisonment for knowing violation. OFrCER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />COMMENTS AND EXPL.ANAIIUN Ur- ANT ViULAI IUNZI (Keference an arracnmenrs nerej <br />ECT TO BURDEN 01 <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used This is a 4-part fonn. PAGE OF