Laserfiche WebLink
PERMLTTEE NAMEIADDRESS rlrufudeFaciliq•NowelbKaganrjDifferenri <br />ADDRESS ?h?• :MINE <br />•? r3UN i 'r' F `AQ I aO <br />u tJS . r , <br />FACILITY Cji' :- ;'`• I NF <br />LOCATION "US ` t <br />rror rrocrtn br,nL T r% ="I, t' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PDISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />? Form Approved. <br />OMB No. 2040.0004 <br />M I NCtI <br />F - r Thi i LPLfr <br />SO(JTI-i - <br />NOTE: Read Instructions bef rd a com feting this form. <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> ? YSIS TYPE <br /> ANAL <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />I'Er <br />REP P. ?QATJ <br /> REQUIREMENT 0A I LZ` ' <br /> SAMPLE Y 4 <br /> MEASUREMENT <br /> PERMIT ittt3! RE:POR I F` _ #at##p p itk It #sb## F.EI(t_ . I?11 I <br /> REQUIREMENT I NF T f'1 t <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT t <br />SAMPLE <br />I <br />MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT t <br /> SAMPLE <br /> MEASUREMENT _ <br /> <br /> PERMIT f <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1- mfy under penalrv of law that this document and all attachments were TELEPHONE DATE <br /> direction or supcmiston in accordance with a system designed <br />d under m <br />r <br />ar <br /> <br />v /j ?? p <br />ep <br />e <br />y <br />to asstuc that qualified personnel properly gather and evaluate the intbrmanon _ <br /> suhmmed Hosed on my ntgwn of the pemin or persons who manage the system, <br />the information <br />the information <br />sibl <br />fo <br />therin <br />di <br />0 <br />h <br /> , <br />e <br />r ga <br />g <br />ose pctsons <br />r- <br />% respon <br />or t ? <br /> submitted is. to the bast of my knoeigdgc mid t chef. into, accurate. and complete SIGNATURE OF PRINCIPAL EXECUTIVE / - <br /> I am await that there !ie sigraficmit penalnes for submittmc false ininrtnalten, OFFICER OR AUTHORIZED AGENT AREA <br /> k <br />i <br />i <br />l <br />u <br />f COOS NUMBER YEAR MO DAY <br />TYPED OR PRINTED ng s <br />n <br />ons. <br />or <br />now <br />a <br />mcludinc the possibility of fine and imprisonment <br />COMMENTS AND EXPLANATIUN Ut ANT vlvlAI IvrVD Irreverence air aua, <br />l <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may tie used. <br />I/C/C/ 'a-.HR PRECIF EVENT IS CLAIMED. EXEM <br />007!?- / (Abl$}(S 4-part form. PAGE OF