Laserfiche WebLink
j NA <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />14 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR r MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br />(( <br />CJ <br /> PERMIT b ; ?,t7-5. ?r 1? t- - <br />i:1iU , REQUIREMENT f•', ; t i i 1:/'f'; <br /> SAMPLE <br />MEASUREMENT n <br /> PERMIT :. •It , . <br /> REQUIREMENT U A`.; <br /> SAMPLE ,{ <br /> MEASUREMENT N /? <br /> PERMIT r x it r - _• <br /> REQUIREMENT <br /> SAMPLE 11- 1A <br /> MEASUREMENT 7 vl <br /> <br /> PERMIT <br /> REQUIREMENT it's : I. <br /> <br />SAMPLE <br />MEASUREMENT <br />f (? l <br />1 lJ U <br />1 <br />L• <br />/ ' <br />n <br />/ <br />?r1 <br /> PERMIT <br /> <br />REQUIREMENT Y <br /> SAMPLE <br /> MEASUREMENT v <br /> r : E:;.. >r . - 'P <br /> PERMIT ,. .• <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMETITLE PRINCIPAL EXECUTIVE OFFICER I corm undo penally ,a law nut thi; document and all attachments %ere <br />ervuion m urcordancc with u ?stcm deigned <br />d <br />d <br />d <br />u <br />zn <br />r w TELEPHONE DATE <br /> nec <br />. <br />a <br />p <br />ptepurc <br />tin <br />er my <br />t <br />i <br />f <br />m <br />ti <br />n <br />i <br />t <br />th <br />d <br />s <br />l <br />th <br />l <br />" <br />-. <br /> uu <br />a <br />o <br />r+onne <br />. ga <br />er an <br />c <br />a <br />c <br />e <br />n <br />or <br />to assura that qtudtt <br />ptoPcr <br />cd Ix <br />ry of th <br />crsonc uhu mnnagc the system <br />b <br />d B <br />d <br />erson or <br />n - • " ?? <br />" . <br />on my inqui <br />e p <br />p <br />su <br />rui <br />e <br />au <br />or those persons ducitly resp.nud+le fur gathenng the mfmmwnun. the mti.rmation ": --.. ?f? ? <br />,A submtu;d te, To dm 1 l)t of my knnwlcdgc atuf hchcf. true. k.uratc. and complete SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am a-arc that there are sttandcunt penalises for whmittmg talc mfortnanon' OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED mcludutg the rosihilm of tine and uupns,nnucnt for Lm•sting siolatwm- CODE <br />COMMENTS AND EXPLANAIIUN UI- ANY viuL.AI IuNJ (Hererence at, ariacnments sere/ <br />HIGHES1 t-VNTHt_! <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />RING PERIO[ <br />l)BI11 'rTLt) W, <br />I hi. is a 4-Bait form.