Laserfiche WebLink
PERMITTEE NAME/ADDRESS tlnclude Faci&y.YamelLocation if Di,Qerenf) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION ;.: d C11 8 1639 <br />t. r i r r I V MANAGER <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 />MIN <br />(:JL <br />F - <br />USC <br />NOTE: Read Instructions before40;41eting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' f.." <br /> REQUIREMENT x <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT c r . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certif> under prn:dt% ,f law that this thwuntent and all attachments were <br />ared unde <br />th di <br />tiu <br />e <br />r <br />u <br />i <br />ion i <br />rdan <br />with <br />-t <br />d <br />i <br />d _ TELEPHONE DATE <br /> pr <br />p <br />r n <br />re <br />n n <br />s <br />pra <br />s <br />n invo <br />es <br />gne <br />cr <br />a <br />ent <br /> to aswre that yaaliried Personnel properh gather and esahwe the. information <br /> vthmitl ed. Bawd on nrr inyuin or the peram or per-r, who mmnage the ryctem. <br /> or those prrstats directly reap a,%thir rue gathering the i.rimmalion, the information ' <br /> snhmilted is. Io the Ixq of m% knowledge and belief, true, accurate, and complete. <br />I ant ..are that there are significant penalties for whmtlting ralw infurnatiun <br />$IGNAT RE OF PRINCIPAL EXECUTIVE - - <br />r I • <br />- <br />- -? <br />TYPED OR PRINTED . <br />including the possibility td fine and ImprB.mtnrnt for knowing tiolatmn, OFF ER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3920-1 (Rev. 3/99) Previous editions may be used. " This i>; 4-part frinn.