Laserfiche WebLink
'•FRMITTEE NAME/ADDRESS,In,-/urL Fnctlfn .Yumclau/imr f1)ijJcrrra/ <br />!:AME <br />ADDRESS ri <br />` ACILITY <br />I OCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER LDISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> <br /> <br /> <br />I+iUR <br />VL'k DW <br />. <br /> <br />Form Approved. <br />OMB No. 2040-0004 <br />N()TF Gnarl Inctn,rtinno hnfnro rn nlof„n this fnrm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br /> <br />>< <br />EX OF <br />TYPE <br /> <br />- AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE <br />! ,. MEASUREMENT <br />< i PERMIT :? _ •.:. .: i _ :_ .• <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 /> <br />f PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ecrufi under penalty of law that this document and all attachments wrrc <br />TELEPHONE <br />DATE <br />- prepaml under my direction or supervision to accordance with a sy,icm designed <br />?" - to assure that qualified personnel properh gather and evaluate the mtbnnatron <br />ub <br />in <br />d <br />B <br />d <br />i <br />f <br />h <br />e <br />s <br />m <br />. <br />ase <br />on my mqu <br />ry o <br />t <br />e person or persons who manage the system, <br />h <br />or t <br />ose persons directly responsible for gathering the information, the intotmation <br />" suhtmucd is. I" the list of my knowfdge and behcf. into, accurate, and complete SIGNATURE OF PRINCIPAL EXECUTIVE <br />? .. <br />- - i efr 16;u tbcrr are sis;nificam penalties for submitting false information. - <br />TYPED OR PRINTED of tine and tin n,ooment li,r knowing violations. <br />p OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />D <br />Y <br />r-/IAAAaCAITC AAIA CV0I AAIATI!\Ski !1C AAIV \/1lll ATIAAIC /n_t______ .- cooE A <br />` T.:-T? 'F N: L 101-- i WILL_ BE WAIVED FOR 63 <br />EPA Form 3320-1 (Rev. 3/99) Previous editiors may be used. This IS:a Apart ford].