Laserfiche WebLink
PERMITTEE NAME/ADDRESS clncl", Freilin•.YomrllocurionfJDijerenu <br />NAME <br />ADDRESS `,:T <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 />NOTE: Read Instructions before completing this forth. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF <br />SIS SAMPLE <br /> <br />TYPE <br /> ANALY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />-.--;rj ?. • 1 REQUIREMENT <br /> <br /> SAMPLE <br />i MEASUREMENT <br /> PERMIT <br /> REQUIREMENT , . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;. -. i <br />- REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certtty under penalty of law that this document and all attachments were TELEPHONE DATE <br /> repared under my direction or superv tston in accurdame with a system designed <br /> <br />- .. ?: - p <br />m assure that qualified personnel propcrl% ether and evaluate the mfurmati,.n <br />submitted. Based on my inquiry of the pcnon or persons who manage the svsivm• <br />the information <br />the mtomtanon <br />for <br />atherin <br />tl <br />n <br />ibl <br />di <br />h - -- _ _ " -- <br /> <br />-?'' <br /> <br />i . <br />y respo <br />e <br />g <br />g <br />ose persons <br />rec <br />s <br />or t <br />submitted is, to the best of my knowledge and heliet, true. accurate. and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- - <br /> I am aware that there arc significant penalties for submitting false information. <br />OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED a ludmg me ptosthihty of firm and imprisonment for knowing violations. CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (He?erence an anacnments nere) <br />EPA Form 3320-1 (Rev. 3,199) Previous editior:s may be used. <br />PAGE OF <br />Ih!s I,? a 4-1-tart tt,rn