Laserfiche WebLink
PERMITTEE NAMEiADDRESS 0,whide Fa ititr Name Location ijDij?nml <br />NAME <br />ADDRESS <br />FACILITY <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 />KlnTF• Panel Inetrrtntinnc hefore comoletinq this form. <br /> <br />PARAMETER QUANTITY OR LOADING <br />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 /> T <br /> MEASUREMEN <br /> <br />-F i PERMIT <br />REQUIREMENT a . - a .: . <br /> <br /> SAMPLE <br /> MENT <br />R <br /> MEASU <br />E <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> T <br /> MEASUREMEN <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEN <br /> T <br />MEASURE <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MENT <br /> MEASURE <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> REMENT <br /> MEASU <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> T <br /> MEASUREMEN <br /> PERMIT <br /> REQUIREMENT <br />NAMETnTLE PRINCIPAL EXECUTIVE OFFICER I cenifj under penalty ,+f law that this document and all attachments acre <br />prepared under m> direction or supervision in accordance wtm a system designed <br />to assure that qualified pcr.onnel prnpcrl} gather and OaIUAIe the infbmation <br />submitted Rased on my inqutrn of the person or persons who manage the system. <br />rt <br />th <br />nati <br />f <br />fo <br />.. <br /> <br /> <br />- TELEPHONE DATE <br />o <br />ormuoon. <br />e m <br />n <br />or ;hose persons directly renponstblc for gathering the m <br />to the best- of my knowledge and hehel. infs. accucu, .md complete. <br />d is <br />?bmin - <br />SIGNATURE OF PRINCIPAL EXECUTIVE _ , <br />e <br />. <br />- <br />r I am aware that there are significant penalties for submitting,:,. - ?•m,atnm' <br />-•_-- .. .. ... ...,.__ . .. _..-:r..t.., ..: a..? ?.,d ..,....,.,„ m for kn,?w r.: \.. ..•. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND-EX?bANATION OF jV l !VIOLATIONS (Reference all attachments here) <br />OR REG O 1 <br />14. <br />- <br />1`I ?. Form 3320.1 (Rev. 3199) Previous editions may used