Laserfiche WebLink
PERMITTEE NAME 'ADDRESS (Include F.n,!« `•.nr„ : ". :hNArnp NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />OMB No. <br />DISCHARGE MONITORING REPORT (DMR) 20x0 0004 <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER :?L AN <br />r:Ar;F TO RCD <br />MONITORING PERIOD <br />FACILITY <br />R MO DAY <br />YEAR MO ?TO <br />LOCATION. FROM l <br />Read Instructions before completing this form. <br />NOTE: <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> <br />NALYSIS <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE I MAXIMUM UNITS A <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />q` REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />c r l REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> G <br /> PERMIT C <br /> <br />r - REQUIREMENT <br /> <br /> SAMPLE <br />- MEASUREMENT <br /> <br /> PERMIT <br />- REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />' <br />: REQUIREMENT <br />J <br />. <br /> <br /> SAMPLE <br /> MEASUREMENT <br />_ <br /> PERMIT <br />- REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />lfi T lI <br />` <br />PERMIT <br />)c -' REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty" of law that this d,wument and all anachmene, were TELEPHONE <br />d DATE <br />prepared under my direction to supervtston to accordance with a «stem designe <br />- <br />vi-manon 1 -- - <br />r to assure that qualified personnel properl, gather and esaltmte the int <br />al on my mqutrv of the person or perms w loo manage the system. <br />• l ' -= <br />tt <br />B <br />' <br />b <br />d <br />an <br />. <br />su <br />mi <br />e <br />. <br />or those persons directly rcspomsihle for gathering the information. the mfimnanon <br />submitted is, to the best of my knowledge and hchcf, tme, accurate. and complete SIGNATURE OF PRINCIPAL EXECUTIVE <br />C I am aware that there arc significant penalties for suhnuning talk in(ortnanon. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED OR PRINTED including the posstb,hly of tine and imprisonment fir lni-Ing %mlauan, CODE <br />COMMENTS AND EXPLANATION Ur ANY VIUL.AI IUrva IrtvrCrerrf V all ?R P9FCTR <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />Y A 1.. fj (s FOR <br />This is a 4-part form. PAGE OF