Laserfiche WebLink
PERMITTEE NAME/ADDRESS include F'ardin Namellocadon ijlhYjennrl <br />NAME _> .:. <br />ADDRESS <br />F-I <br />FACILITY t- <br />LOCATION t, CS 1 ?! c <br />)" I.fal.T1F rtuE MANAC-1i:R <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 />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO FREDUENCY <br />OF SAMPLE <br /> <br />EX <br />ALYSIS TYPE <br /> AN <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r;Y <br /> REQUIREMENT = + _' <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <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 /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that thb drwunnnt and all attachmenn were TELEPHONE DATE <br /> prepared under ms direction or wpenision in accordance with a ssMem detigned _ <br /> to a are that qualified personal pn,perl) gather and esaluale the information s <br /> nuhatitted. based an m% inquire td the p-n or perMms who manage the system. <br />- - or those person, dhr -Il-s responsible for gatihrring the information. the information <br /> .ubmitted is. to the hest or my knowledge and better. true, accurate. and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />" i rem nwure that there are sigoirwant penalties fur suhmttting false information. AREA <br /> risonment for knowing riolations <br />ihili <br />of fine and im <br />the <br />i <br />l <br />di OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED p <br />nc <br />u <br />ng <br />p w <br />ry <br />COMMENTS AND EXPLANATION OF ANY VIULA I IUNb (Kererence an anacnmenfs nere/ <br />R 10YRl24HR PRECIP EVEN'r - S`rE I A. 2r <br />PG 20. 30 DAY AVG IS HIGHES•r MONTHL`f <br />EPA Form 3320-1 (Rev. 3/99) Prewcos editicns may be used, nis is a 4-pat fmn-