Laserfiche WebLink
PERMITTEE NAMEIADDRESSpweVbFw*tyNw?L«n/ow(/D(06r t) <br />NAME <br />ADDRESS 1 <br />• ?. 3U1L 1?:SU <br />FACILITY J J 1 J i? !: l ('1 C IJ.?. Ii i I <br />LOCATION <br />R PALi.iAt;z cc <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />"INLh <br />(,Jn6 Lw) <br />F - fIhAI <br />PUaiJ 1i TG <br />NOTE: Road Inatructione boflxs Completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. U <br />NCY <br />FREO SAMPLE <br /> O <br />F <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r c • `- ° , _ <br /> REQUIREMENT <br />N y <br />I. V <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br />1 <br /> MEASUREMENT <br /> PERMIT Y,:?ZV ..rCFT <br /> REQUIREMENT <br />L n 1. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;• .: >? ?, Y <br /> <br />F C s: <br />; <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT !:. iicFGiiT rL1 1 1A <br /> REQUIREMENT <br /> Ally 7E <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' reran under pens ly 0 law that Ihls document ¦nd all .11whments were TELEPHONE <br />d <br />d <br />i <br />i DATE <br />Prepare <br />un <br />er my d <br />rection or superv <br />don In accordance with • sy,tern designed <br />- t <br />a <br />th <br />t <br />lifi <br />d <br />h <br />o <br />ssure <br />a <br />qua <br />e <br />personnel property gat <br />er and tvNume the information <br />submitted. eased on my inquiry of the person or persom who -age the ,ysirm <br />, <br />or those pmom directly respondbie for gathering the Information, the Information <br />submnled Is, to the lent of my knowledge and beW <br />true <br />aceumle <br />and c <br />t <br />m <br />l / <br />. <br />, <br />. <br />e- <br />o <br />p <br />e <br />I am aware that then are dgnifiowt penalties for submitting fain Information, SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Including the poalbllily of fine and Imprisonment foc knowing •lolatloem OFFICER OR AUTHORIZED AGENT CAREA I ODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION UP ANT VIULAI I IUNS fFfNorenc• M •ttocnmenta here) <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-pan form. PAGE