Laserfiche WebLink
PERMI-iIEE tWNIE:ADD, -,,s <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION r- <br />F, O( <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD t <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE T <br /> MEASUREMENT <br /> <br /> PERMIT <br />.`: REQUIREMENT <br /> SAMPLE , <br /> MEASUREMENT <br /> PERMIT sF; s# •;S rit (., z?r x , <br />- REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br />r ! <br />Jr(1 <br />J <br /> <br />/ <br />?r? <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT (- <br /> PERMIT <br />s ` [- - REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />- -'i;?`!% i_ 13 1 i REQUIREMENT r r <br /> <br />1 <br />' SAMPLE <br />' O = ! <br />q41 A CH. <br />- L <br />.) MEASUREMENT KJ v <br />{ PERMIT r r__ <br />'•t _ T5 BF, REQUIREMENT MI's VALUE T <br /> SAMPLE <br />F'.F? Cli MEASUREMENT <br /> PERMIT <br /> REQUIREMENT Ai <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I certify tinder penalty of In% that thn document and all attachment, were TELEPHONE DATE <br /> prepared under my direction m supervision in accordance with a system designed <br />h <br />d <br />r+ I at qualifie <br />to assure t <br />personnel properly gather and cwluatc the mfimnaron <br />submitted based on my tnqutrv of the person or perverts who manage the system <br />I I <br /> . <br />or those person; directly responsible for gathenng the information, the intimation h <br /> submitted is. to the best of my knowledge and belief' true, accurate. and complete. <br />I <br />m <br />th <br />t th <br />r <br />t <br />iti <br />lti <br />f <br />b <br />i <br />f <br />l <br />fi <br />i SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> <br />TYPED OR PRINTED a <br />aware <br />ere a <br />c ugn <br />pena <br />mnat,n. <br />a <br />can <br />es <br />or su <br />m <br />n <br />ng <br />a <br />se m <br />ncluding the possibility of fine and impnsrmmcty for knowing violations <br />OFFICER OR AUTHORIZED AGENT <br />AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />?4FF'F <br />EPA Form 3324.1 (Rev. 3199) Previous editions may be used. <br />U T FALL. 1F <br />DIF•F BTWN <br />This: is a 4-part form. PAGE OF +