Laserfiche WebLink
PERMITTEE NAMEiADDRESS rlr,; i:.dr Paeilin- Nome Loentltut if Diffe•trnu <br />NAME <br />ADDRESS <br />FAC I UTY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />tl1- <br />( <br />F -- <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br />EX FREQUENCY <br />OF <br />ANALYSIS SAMPLE <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />SUREMENT <br />ME <br /> A <br /> <br />-t--- , PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> 1 ' <br /> <br /> <br /> <br />•: _ , I ,,? <br />PERMIT <br /> <br />REQUIREMENT <br /> <br />Sir) r1rlr} <br /> <br />s=? . <br /> SAMPLE <br />MEA <br />REMENT <br /> SU <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />UREMENT <br />MEA <br /> S <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />ASUREMENT <br /> ME <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASU <br /> PEREQUI <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICE under penalty of taw that this document and all utiachntctim were <br />d under my direction rrr supeniswn in accordance with a system desgzm d <br />% TELEPHONE DATE <br />-- re that qualified personnel properly gather ,md evaluate the information <br />ted. Bawd on my inquiry of the person or persons who manage the system. <br />information <br />t <br />th <br />h <br />i <br />f <br />h <br />i <br /> <br />- - - - - - <br /> ion- <br />e <br />n <br />orma <br />er <br />ng t <br />e <br />e perwns dircth responsible lot gat <br />to the best of my knowledge and belief. true, accurate and complete <br />ted is SIGNATURE OF PRINCIPAL E CUTIVE <br /> . <br />are that there an significant penalties for subnvtnng false information. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TVDCn na PRINTFn v, the Possobihty of fine and unpriwnment for knowing siolations, <br />Iudmv, C ODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />' <br />R. El <br />X iC iTY <br />i rl r 5t.,.. L) F <br />EPA Form 3320-I (Rev. 3(99) Previous editions may De used. <br />SO -- STATISTICAL. POINT I <br />RIEPORT FORM Ta DMR. <br />- - PAGE - O -