Laserfiche WebLink
PERWTTEE NAME/ADDRESS(7-A- tf.AiryN..?L«rmn(/Dt66-,) <br />NAME <br />ADDRESS ' <br />b 0 A <br />jYsU <br />FACILITY t L) zi I D L a U re l t: G u '1 h f'i j; <br />LOCATION h P A L i'Sn L I C I? <br />Form Approved. <br />NATIONAL POLLUTANT DISCHMGE ELIMINATION SYSTEM NPDESI OMB No. 2040.0004 <br />DISCHARGE MONITORING REPORT W MR) <br />PERMIT NUMBER DISCHARGE NUIMBER _ I .a ¢ <br />MONITORING PERIOD -G L': F d L C Ei I Y: h <br />YEAR MO DAY YEAR MO DAY <br />FROM _ TO <br />NOTE: Reed InBtructions before itiomaleting thlt form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, NCY <br />FREO <br />U SAMPLE <br /> O <br />F <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br />. a <br /> REQUIREMENT <br /> ,- n K 1 '! U r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />V <br />' <br />/ <br />t <br /> REQUIREMENT :J Y ? ls' A <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />r <br />=e ?• i <br />r : L <br /> REQUIREMENT a ' Y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />JL tti <br />!1 l L j ? <br />1t? i?. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />i. f. <br />1 C <br /> REQUIREMENT IhS1 "Pa :,i <br /> SAMPLE <br />y MEASUREMENT <br /> PERMIT A tFC. <br /> REQUIREMENT ? L Y <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER 1 certty under penalty o I.w that thh ion menl and di attachments wrre <br />l TELEPHONE DAT <br /> <br />prepared under my dlrtct <br />on or superHSlon In accordance with ¦ system damned E <br /> Io aasurr that qualified personnel propt. y gather and evaluate the Information <br /> submitted. Bred on my Inquiry of the person or persona who manage the sys/rm. <br />or th <br />di <br />l <br /> ose prrsom <br />rect <br />y respordble for gathering the Information, the information _ <br /> submitted is, to the belt of my knowledgt and belief, true. amrnte, and rompk/e. <br />1 am aware that they: an significant penalties for submitting (she Information, <br />SIGNATURE OF PRINCNAL EXECUTIVE <br />' ? <br />TYPED OR PRINTED Inciuding the poodblllty of floe and Imprisonment for knowing ridatlom OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />?.Vmmue r a nrsv cnr s.rarers ..v.. ... .-.... ....?........v r•..r .. ...?. a. w.rwerrnrwnea n.rq <br />hIt CA- it's L t1?h1 C.(.CUPr , z?i;L-, JEC I 7C ELfiLFN Li FECCF <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. <br />This is a 4-pan form. <br />i