Laserfiche WebLink
PERMITTEE NAME/ADDRESS tlnrtude Facilifx.V'amel/ocation if Differenrl <br />NAME <br />ADDRESS <br />FACILITY ? 'L - <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <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 />OMB No 2040.0004 <br />1I NOR <br />i 'UBR <br />•..• ? 1. i?{Ai! i-li`i i i"C: <br />5R°.-OMU%4`c IiRta:? ?R 1 -3 TO TUT ILE EIR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQDUENCY SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />? <br /> MEASUREMENT i <br /> PERMIT <br />F c_ ?. _ . <br /> REQUIREMENT i Nss'r t", <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certif% under penalty of law that this document and all uttachment+ Nett TELEPHONE DATE <br /> prepand under my direction or snpeni%ion in -vorda"t, %ith a +smrm designed <br />-- <br /> to aswre that,luntYed Personnel properly gather and evuluatr the information <br />-. submittal. Raid on nn inyuin of the lteratro or la•r on, who manage the ystrm. <br /> or Ih- prm,n, directh msptm+ibl< for gathering the information. the information _ <br /> accurate <br />at the hest of ro <br />knonkdge and belief <br />tote <br />and eomplrt< <br />whmith-d is <br /> , <br />. <br />p <br />, <br />. <br />. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I um a%am that there am significant <br />pp <br />i%o <br />+ <br />i <br />+uht +fa lioselutions information. <br />t for for knottin <br />e and im <br />i+ <br />th <br />ibilit <br />ff <br />i <br />l <br />di OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED r <br />nm <br />y o <br />n <br />r <br />a <br />xn <br />g <br />ng <br />e pass <br />i <br />nc <br />u D <br />COMMENTS AND EXPLANATION OF ANY VIOLA IIUNS (He?erence an arracnmenrs nere? <br />EPA Form 3320-1 (Rev. N99) Previous editions may be Used k This is a $-pattform.