Laserfiche WebLink
PERMITTEE NAMEIAODRESS pweim&ra tMryNo.,wL?rlm, ((D(r.. ) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT 04SCHAROE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER asCHAROE 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 Instructloo before completing this form. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO, <br />UENCY <br />FREQ <br />SAMPLE <br /> 1>< O <br /> EX ANALYSIS TYPE <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 /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEfnnE PRINCIPAL EXECUTIVE OFFICER teen"r " F- 11y *(I*- that this docvrnenl and as .n.rhmvitf were <br />TELEPHONE <br />DATE <br /> prep.red ruder, my dtrsctbm or sup. on In accordance with . system designed <br />I <br />. <br />.c 'f ; to assure that quahned personnel prgwri7 gather and tealuate the Information <br />submitted. aaoed on my Inqutry of the person or pen who manage the s <br />stem <br />, y <br />, <br />or thole penes directly responsible For gathering the Information, the Information <br />_ subodited le, to the best or m7 knowledge and bdW, Inar, accvnte. and compkte. <br /> 1 am aware that then am slgMlkent penaltle for submitting War Inromtedon. SIGNATURE OF PRINCWAL EXECUTIVE <br />TYPED OR PRINTED Including the possibility of fine and Imprisonment For knowing siolaUotet OFFICER OR AUTHORIZED AGENT AREA NVMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EAFLANA I wrv Vr APIT VIVLA I IVN5 fffslerence an affact)ment1 hers/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-part form.