Laserfiche WebLink
PERMITTEE NAME/ADDRESS(h.rV&FweWyNa.aJLararfon(/Df?i..t+! <br />NAME <br />ADDRESS <br />FACILITY "IYO <br />LOCATION :=R <br />NATIONAL POLLUTANT DiSCHARGE ELIMINATION SYSTEM /INPOES/ <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 />OMS No. 2040-0004 <br />NOTE: Read k»trvctione before completing We form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANAlY515 <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 /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />I F <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 ceruty u pen' ty o aw that thh dwomeM and all .Itrhmeob wen TELEPHONE DATE <br />prmparmd rndef my dirctlon or wlperrtfon In a-rdanrm with . system designed <br />to assort that II-Mrled perwnnel properly [.then and evaluate the Information <br />wmbmllled Bred oo m Inquiry of tae one who man <br />y Penon o. Wn age the fmslcm, <br />or Ihor peraoma directly mpanlble roe gathering the Informnatlon. The Information _ <br />mbmitted 14 to the bet of my ?nowkdge and besef• tree. accurate, and Complete. <br />nifk-I <br />SIGNATURE OF PRINCNAL EXECUTIVE <br />t then <br />/ <br />enam <br />fo <br />b <br />lta <br />I <br />r <br />tl <br />I <br />th <br />F <br />I ' <br /> am .wan <br />arm a <br />g <br />r <br />e <br />r wm <br />m <br />a <br />ng <br />. <br />. <br />n <br />nrm. <br />on. AIF <br />TYPED OR PRINTED Im*WIng the peadbluty or 11w and Imprlaoement for knowing WaLln OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference sM attachments her*) <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This IS a 4-part foRt1. PAGE OF