Laserfiche WebLink
PERMITTEE NAMEIADDRESS tinelude FariUry Yam llin-utinn if llifferrep <br />NAME <br />ADDRESS <br />FACILITY IJ-Wi I <br />LOCATION f <br />hNC i= : t--!F MAI,4A(i ER <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 <br />NO. FREQUENCY <br /> <br />OF <br />SAMPLE <br /> <br />EX <br />LYSIS <br />N TYPE <br /> A <br />A <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT r. - : .. , <br /> REQUIREMENT ' _ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT .: <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> _ . _ <br /> PERMIT i. <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT _ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penally of law that thi, document and all attachments were TELEPHONE DATE <br /> prepared under my direetion or suprrsisinn in accordance with a systcm designed <br /> In assure that qualified prnonnel properly gather and rsuluatr the information - - <br />- - submitted. Based on my inquiry of the prrsm or Persons who manage the system. <br />-- or there persons directly re-sponsihie ror gathering the information, the information <br /> suhmitted is, to the best of my knowledge and iwoer. true, accurate. and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> lam aware that there are signineant Penalties for submitting bd.e information. AREA <br /> siolution, <br />d im <br />-nment for knuwM <br />ibilit <br />f fin <br />a <br />di <br />th OFFICER OR AUTHORIZED AGENT D NUMBER YEAR MO DAY <br />TYPED OR PRINTED g <br />e pos <br />y o <br />e <br />n <br />pr <br />inclu <br />ng <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />PRECIP EVENT - SEE I <br />)AY AVG IS H I GHE`3"T M1FJ 1 <br />EPA Form 3320-1 (Rev. 3i9g) Previous editions may be used. Thiti is a 4-part fOTitl. PAGE OF