Laserfiche WebLink
PER MrTTEE NAME/ADDRESS (..&& FaNUry )Ww?L«.r,an If D(#6-#) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER LEI cHAROE 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 Itt.tructlons before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE =MAXIMUM UNITS <br /> SAMPLE C:.. 7 1 <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 />REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER 1e^'Iy " Pena ly o .w that fhb davrrrnl and Oil auerhmrnu wen TELEPHONE DATE <br />prepared alder my dlr.ttbn a.tperrfelon In aecoedann w11h . tyelem dnltned <br />to assure that quallMd personnel properly tatber and evaluate the Inrnrrnallon <br />submitted. Based on my I"Wry or the person « it, s who mattate the system. <br />£ or plow person. areetty responsible ror iathrrtnt the lnror,nauow, the tnrormatlon <br />wt miltted b, to the bnf of my Lnowledte and better. live. "rntrsle. and complete. <br />SIGNATURE OF PRINCIPAL EXECUTI`W <br /> I am swam chef them are sltNncathf penaltfes for submltelnt raise Inro-estfon, AREA <br />TYPED OR PRINTED 1nrludlnt the possibility a rim end lesprfson-1 ror bnowint Aol.tla OFFICER OR AUTHORIZED AGENT CODE NUMSER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aM attachments here/ <br /> <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used 'I 'his is a 4-part forin. PAGE Of