Laserfiche WebLink
PERMITTEE NAME/ADDRESS Innclude F•ad(ity NamelLocation if lwffcrenq NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION FROM YEAR MO DAY TO YEAR M DAY <br />Form Approved. <br />OMB No. 2040.0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br /> <br />OF <br />SAMPLE <br /> EX TYPE <br /> ALYSIS <br />AN <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penally of law that this document and all attachments went TELEPHONE DATE <br /> prepared under m} direction or sopenision in accordance with a %s,,tern drugned <br /> In awwre that qualified penormel property gather and esaluate the information <br /> submitted. Raved on ms inquin or the pensm or pervm,, who manage the system. <br /> rr those persons dimeti., responsible for gathering the information. the information <br /> sulsmiued is. to the tarsi of m> knowledge and belief. true. accurate. and complete SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that them art significant penalties for submitting falw information. <br />.iod <br />tio <br />s <br />h <br />ibilit <br />nt fo <br />knowi <br />i <br />l <br />di <br />f f <br />d i <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED . <br />ine an <br />mpr <br />sonme <br />r <br />ng <br />a <br />n <br />nc <br />u <br />ng t <br />e poss <br />s o <br />CODE <br />COMMENTS AND EXPLANATION OF ANY <br />(Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-part form.