Laserfiche WebLink
RPAfTTEE NAME/ADDRESS rlndadr Fbrilitr Ya r1bo •atirnt if biller "'11, <br />NAME <br />ADDRESS <br />! C-SP ERUS <br />FACILITY i'•iG?r <br />LOCATION ;. jPERUS i. t! 8 <br />.acv RFC:=_-r ?=... , - .- '"t`4071yEEF <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 />I NOR <br />;UBR C"- <br />i <br />NOTE: Read Instructions before completing this form. <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION , OF <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 /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT i <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ' - <br /> PERMIT 1 <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 errul% under Ixn:dt of Iew th;tt Ihi, d..rumrnt -1 Al atfurhtnrnt, wrrr .' TELEPHONE DATE <br /> prt-pan•d undrr iii. dircr-lim nr wlxr.t,inn it, a cu..Nnvr with a ,.,trm dr,i¢ur 1 <br />, r --. r - to ;r,un• Ihw qurlifitd I.,-,nnrl pnytrri) eatlxr .utd r, An;,I, the antnrwation ' <br />I - ,uhmithd. fta,rJ un me utywn of the {x non or Ixr ut. who manailr 11--tam, <br />_ <br /> .rr Ils <br />,- prnnn, dtrratle re,pomddr for g; stl nny: the mGrrmaltnn, the inf-trulion ??---?? `? /• <br /> : <br />.ubn iuevl t,. V, the I-I wf me LnnwlydEr :utd Ixhef. trua, do orate. .md -n,pirtr_ <br />SIGNATURE OF PRINCIPAL EXECUTIVE _ <br />-. .• t !.. <br />- i <br />ti ?i ; ( , <br /> I am aware Ihal there arr,il;ntfi-rat prnalttr, for whmitlinp FA- infonnehntt. OFFI <br />R AUTH <br />RIZED AGENT <br />ER AREA <br /> <br />TYPED OR PRINTED inrludin:; Ittr I>. -il,dil, of rinr and un In-i.omnrnt for ko-mI: i Irlinn,. <br /> <br />` C <br />O <br />O NUMBER <br /> <br />CODE <br />YEAR <br />MO <br />DAY <br />GUMMENTS AND EXPLANAIIUN UF- ANY VIULAIIVrvJ (rrererence an arracnmenrs here/ <br />.- C IF <br />i. <br />.)B%.II CI' TO BURDEN OF PROOF <br />310N WITHIN 40 HCJ! V,!,?. <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used.