Laserfiche WebLink
PERMITTEE NAME/ADDRESS dacttdr FadUrl Nameffvcatiun i)'DiJfrrrta) <br />NAME <br />ADDRESS t <br /> <br /> _ H C; <br />FACILITY i DF f`t I t IF <br />LOCATION ,A L <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NIDDE'S) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />_ YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />M I NOR OMB No. 2040-0004 <br />(5UBR r. <br />F- F I iVAL i 7NTR S <br />Sri%.:MINF_ i1RN TRID TO T?,i`TLE L)R <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 <br /> PERMIT <br /> REQUIREMENT T. II\t 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT V G <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />. r <br />r-, Li M I <br /> REQUIREMENT fiV s' <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I rerliry under penalh of taw that this document and all attachments were <br />ared under m <br />re <br />direction or su <br />-Wort in accordance with a s <br />stem designed TELEPHONE DATE <br /> p <br />p <br />? <br />p <br />y - <br /> to assure that qualified prnonnrl properi) gather and evaluate the Information <br />' submitted. Based on tai inquio of the person or persons who manage the s) stem. <br /> or those parwns dir d's responsible for gatherinl' the Information. the information <br /> submitted is, to the best of ms knowledge and belief, true, accurate. and complete. <br />I <br />ware that ther <br />r <br />i <br />ific <br />t <br />n <br />lti <br />ub <br />itti <br />f <br />F <br />l <br />i <br />f <br />ti <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />' <br />TYPED OR PRINTED am a <br />e a <br />e s <br />gn <br />an <br />pe <br />a <br />es <br />or s <br />m <br />se <br />ng <br />a <br />n <br />orma <br />on. <br />including the w-ibilin of fine and Imprisonment vnment for knowing % i lotions. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. - This-}s a.4-part f0 mi.