Laserfiche WebLink
PERMITTEE NAME/ADDRESS (7.o& ForOryN&rtLxaelar ((D(&,t) NATIONAL POLLUTANT OISCHAAOE ELIMINATION 3Y5TEM //NPDES/ _ Form Approved <br />NAME DISCHARGE MONITORING REPORT (DMR) OMB No 2040.0004 <br />ADDRESS <br />PERMIT NUMBER ICHAROE NUMBER <br />NEI' MONITORING PERIOD <br />FACILffY <br />LOCATION FROM YEAR MO DAY TO YEAR MO DAY <br />NOTE: Read Instructions before completing thlB form. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. FREOUENCr <br />SAMPLE <br /> OF <br /> EX ANAtrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> <br />- SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> <br />REQUIREMENT _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME/TME PRINCIPAL EXECUT VE OFFICER I eenlty ° pen' ly 0(18w that thh dor°'nent and a1I sttach=.rre <br />%`• TELEPHONE <br />DAT <br />re ¦m1 undee ,n direction or su <br />p p f penhlon In accordann with a ,stem dtdgne6 E <br />to sauce that qualified pertonnei property gather and eyaiuate the Inre-nat{on <br />" <br />submitted. Bred on my Inquiry or the person or peraorn who ,,nate the system, - _ , <br />I <br />- or <br />ho'a per7ore directly repnndW for gathering the Info-tlon. the lnformatlon <br />- subrltted b, to the bet of my knowledge and ba f, Irv., a rate. and romplele. <br />-- <br />I .m ¦wam that there are sitniftcant penaltle roc submtlNng Ww Inf.,natlon, SIGNATURE OF PRINCNAL EXECUTT/E <br />TYPED OR PRINTED ImWInt the Passibility *(Am and Imprisonment for knowing rlolatl r OFFICER OR AUTHORIZED AGENT COQ NUMBER YEAR MO DAY <br />COMMEN 15 AND EXPLANA I IVN Vr AN T V IVLA I IVNa Irrorerenc• en •rrecnmenrs norel TOTAL SUSPENDED SOS T OS (TSS), TOTAL I R <br />• 'i1r1 t PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used 4 This IS * 4-pan form.