Laserfiche WebLink
PERMRTEE NAME/ADDRESS17.e&&F.wiyN...r L.c.rson(/D(Qirwr) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <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: Road kntrucdone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOVENCY SAMPLE <br /> <br />EX OF <br />T <br />E <br /> ANALYSIS YP <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />I revery a r pen. ty o (law that this don mrnt and all attachments went T <br />TELEPHONE <br />NAME/77TLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />prepared antler my dtreellon or supervNon In accordance with . system designed <br />to nsum that qualified pc mnel properly gather and evaluate the Info lkwi <br />. submrtled. Bared on my Inquiry of the person or Persons who manage the system. <br />th <br />ll <br />sibl <br />f <br />I <br />1 <br />y -Pos <br />or <br />ose persons dlrec <br />e <br />oe EatherlnE the <br />nformallow, the Infor-ed.. <br />• <br />' <br />... y ..' ., ?:- <br />•r„(. /4 submitted Is, to the hest of my kmwledEe and bellef. trve. a rule. and compkle. <br />r am aware that there are sl <br />Jflu.t <br />enaltfe, f <br />SIGNATURE OF ?RINCI?AL EXECUTIVE <br />r <br />bmiltl <br />r <br />h <br />Int <br />-ll <br />. <br /> ga <br />p <br />o <br />su <br />nE <br />a <br />e <br />o <br />o <br />, AREA <br />TYPED OR PRINTED Ineh.dlnr the Possibility of floc and Imprimomenl fa snowing Oolatlom OFFICER OR AUTHORIZED AGENT CODE NVMt3ER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fReforenc• ell effacnmonfs here/ <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This IS a 4-part form, PAGE OF