Laserfiche WebLink
PERMITTEE NAME/ADDRESS (include Facility \amelLocarion iJ'Aij/ereu) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION I ?3 <br />f<aFn. c--Fri r;MA7 TnN MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DIVIR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0003 <br />f <br />(SUB): <br />F - F. <br />UE <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <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 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif% under Penalty of law that this document and till attachment, wrre TELEPHONE DATE <br /> Prepared under m-s <Iirm tion or -Per%won in accurdanee with a system designed <br />? <br /> to assure that qualified Personnel properly gather and evaluate the information r <br />I <br /> submitted. Rased on m) inyuin of the person or Wsons who manage the ystem, <br />l <br /> or those pervert direclh responsihh- for gathering the inrormaliun. the information <br /> sahmitted is. to the bs-st oil m, knowledge and helief, true- accurate. and complete. $IGNATIf'1RE OF PRINCIPAL EXECUTIVE <br /> I one aware that there are significant penalties for submitting falsr information, <br />iw <br />ent ro <br />owi <br />sio l <br />i <br />l <br />lli <br />h <br />iMlits <br />f ftm• <br />d im <br />k <br />tions <br />OFFtTCER OR AUTHORIZED AGENT <br />AREA NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED e 1- <br />o <br />an <br />pr <br />nm <br />n <br />a <br />- <br />no <br />u <br />ng t <br />r <br />ng CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rererence an artacnments nere) <br />EPA Form 3320-1 (Rev- 3+99) Previous editions may be used. 00032 ' Tli%lii? a 4-parC'f6ml.