Laserfiche WebLink
PERMITTEE NAMEMDDRESS (T--64FaedYyo-*'Lxaero.(/DI W"I) NATIONAL. POLLUTANT DISCHAROE ELIMINATION SYSTEM /INPDES) <br />NAME DISCHARGE MONITORING REPORT IDMR) <br />ADDRESS <br />. :OX 14 _ PERMIT NUMBER DISCHARGE NUMBER <br />1 AUL MONITORING PERIOD <br />FACILITY p j j U E S U L; 1 u L t: 4. YEAR MO DAY YEAR MO DAY <br />LOCATION R E A L 1:, A L t C C FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />- riaaJ- <br />'0 1,, L;/ ?( CCAL CFiiK <br />i <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. U NCY <br />rREO SAMPLE <br /> O <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT n L Y <br />• REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT L Y ` .? I t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT Yo <br />:•, <br />ni1LcT <br />n <br /> REQUIREMENT + I 1 Y !' A i C. L Pt 7 is <br /> SAMPLE i ) <br /> MEASUREMENT <br /> PERMIT C <br /> REQUIREMENT v L ;. n z ; et Z 1 Y; :V 1 F <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :, .. <br /> REQUIREMENT T Z <br /> S A MPLE I <br /> MEASUREMENT <br /> PERMIT i- f C ::: v - .• ; <br /> REQUIREMENT i r:. - I L Y 14 X <br /> SAMPLE l <br /> MEASUREMENT <br />, <br />PERMIT L E c it <br />- <br />REQUIREMENT <br />1 cer ity under pen. ty .(I.. that I" document and .II .11ar:hmeni., were <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />di <br />l <br />1 <br />DATE <br />prepared under my <br />mvi <br />on or wper+ <br />on In accordanre with • system designed <br />h <br />to a7nure t <br />at qualified personnel properly gather and evaluate the Information <br />submitled. Bard on my I"ulry or the Pen or Persons who manage the s <br />stem <br />y <br />. . <br />or (how persons dirwIly mpordble for gathering the Informallon <br />the information <br />• <br />submitted It& to the best (.v kno.l dge and better, Im.. a raw and complete. <br />I am .+.re that there are dgnln-t penalise, for whmitisng hhe Inrnrmaison <br />SIGNATURE OF PRINCIPAL EXECUTIVE I <br /> . <br />i <br />i <br />TYPED OR PRINTED - <br />ding ih. poa,thiw, or n- and trrmp is nment for kno.Ing Hel.8- OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANA I IUN Ur An T VIVLM I IVNa werorencs M srrscnmsnrs norst <br />LYiOI CC.CUR3, LUEJ?C1 IC PGtiLLN Ci F;CCF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a -L-Part turn. PAGE <br />i