Laserfiche WebLink
PERMITTEE NAME,'ADDRESS hiclude Fa-din' A'ame:7. oncur rjDiJerenn <br />NAME <br />ADDRESS <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />Form Approved <br />OMB No. 2040-W04 <br />LAN <br />N <br />MONITORING PERIOD <br />FACILITY YEAR MO DAY YEAR MO DAY <br />LOCATION ' FROM TO <br />NOTE: Read Instructions before completing this form. <br />FREQUENCY SAMPLE <br />NO <br />. <br />QUANTITY OR LOADING QUALITY OR CONCENTRATION EX OF TYPE <br />PARAMETER <br />ANALYSIS <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT j <br /> <br /> <br /> PERMIT <br />•,} <br />`i. _ <br />?-iE W REQUIREMENT <br /> SAMPLE <br />r ' <br /> MEASUREMENT Et> ' _? U <br />?? r r <br /> , a ## h ## It N <br />_F <br /> PERMIT h: 1=f JIk T C r. ;...t s r ? tc•It# MONTH <br />_ . 7} REQUIREMENT ti? to A`? r, <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />TELEPHONE <br />DATE <br />I emvfy under nalty of law that this document and all attachments were <br />NAME/TITLE PRINCIPAL IXECUTIVE OFFICER <br />direction or super, ston m accordance with a system designed <br />d <br />d <br />d - <br />er my <br />un <br />prepare <br />rotte <br />to assure that qualified per ,mtel properly gather and evaluate the information <br />>? .. ;'L...,. - r, submitted. Based on my inquiry of the pcrnm or Nrsons who manage the system. .. _, ?• ; ? , <br />f <br />ormatron <br />or th» pmons directly reslrmsible for gathering the information. the tn <br />and complete SIGNATURE OF PRINCIPAL EXECUTIVE i --- <br />accurate <br />we <br />and behel <br />k <br />wl <br />d <br />! -i , <br />. <br />, <br />ge <br />no <br />e <br />submitted is, to the best of my <br />I am aware that there are significant penalties for submuring fad inkormauon. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />.. nn nour7er? including the rrossihthtc of fine and imprisonment far knowing violations <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />I S? Nt"; ht " L <br />EPA Form 3320-1 (Rev. 198) Previous editions may be used. <br />PORTED MONTHLY REGARDLESS OF WHETHER AN E <br />11)1, t• :t -1-prim burr.