Laserfiche WebLink
PERMITTEE NAMEIADDRESS (include Facilirp Aunic I,, anon ilbiff?r, tit <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY <br />FROM TO YEAR MO DAY <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />("LIBR <br />F - F <br />SUFI FA <br />NOTE: Read Instructions before completinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREOUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br />4 23 <br />-7%A <br /> <br /> PERMIT -: r > <br /> REQUIREMENT ; ;t ryii ir= _ i '.?I i E It:•}!:' ," '• <br /> SAMPLE <br /> <br />MEASUREMENT _ <br /> PERMIT <br /> REQUIREMENT 1t; D <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE ` <br /> MEASUREMENT `B, <br /> PERMIT <br /> REQUIREMENT J? ?1 "; ' { < <br /> SAMPLE <br />R 2l? E <br />R- A$ <br /> MEASU <br />EMENT -.-- , <br /> PERMIT 1i Lj"i 77 -- <br /> REQUIREMENT VG v' MONTH <br /> SAMPLE <br />f <br />1 / <br />A <br />IA <br /> MEASUREMENT r, <br />, N <br /> PERMIT ?t : ? <br /> REQUIREMENT Of T <br /> SAMPLE ' <br /> MEASUREMENT t 22 l ICI 5 <br /> PERMIT " „. ?. <br /> REQUIREMENT - <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER l certiry under penult),dbs, that this d-ument and all alt-hmrnt, were <br />- <br />d <br />l TELEPHONE DATE <br />- pn <br />l-r <br />nM <br />er my dirtwfim i super, i,ion in aca,rdaner with as ' % ,Iem dr,irmd <br />b, a„ure that ymhrild pers• nnrl prnperh paiher and rs aluatr Ihr infnrmpti,rl <br />- - <br /> <br />- ' -t -- <br />,uhmitled. Bused nn m% inyMrs of the perMm or perwln, who manure the s,,lem. ` <br />- <br />- or th,xr perm, directts recp,msildr for gathering the information. the information ' <br />' '- whmltletl is, to the lw•,l ,Ir nn AM,whdgC and Iw•lkf- 1ruC. :ICWrale, and complete. <br />1 am aware that th <br />re <br />fo <br />r <br />si <br />if <br />ca <br />t <br />alti <br />uh <br />ilti <br />f <br />l <br />i <br />f <br />t SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED <br />rnpp...-.?.. ...., .I.T 1 e <br />a <br />e <br />gn <br />i <br />n <br />pen <br />es <br />r , <br />m <br />ng <br />a <br />se <br />n <br />orma <br />ion. <br />including the prn,ibilih of fine and imprisonment for Anowing,i,datilms- <br />.?..,..., ..... .. .. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />COD <br />YEAR <br />MO <br />DAY <br />?E. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used <br />D065 <br />4-part font). PAGE OF