Laserfiche WebLink
PERMITTEE NAME/ADDRESS17fto"Frtbry Na-WL«atarl/D(Qbnnr) <br />NAME <br />r <br />ADDRESS <br />1:5 1 V f <br />C <br />LOTIO •,U IUE NUh•Ih t ScU'lh mli <br />LDS Ft k1%L15A)6 CU <br />Form Approved. <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT IO R/ <br />PERMIT NUMBER D'S""AROE NWBER r y n <br />- MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />15 FROM TO x <br />NOTE: Read Instructions before eomoletlna this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. UENCY <br />FREG SAMPLE <br /> D <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L0 t,Kl1it ;r; t <br /> REQUIREMENT <br /> r a ?. a <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ;tLi•Co7' <br />i <br />` <br /> REQUIREMENT <br /> 1' <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT R - <br />no =">1tPjr, ti <br />?•.YCrZ <br />N.tr%t ? <br />t <br />c:.? <br /> REQUIREMENT <br />M <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L t V :: L F <br /> REQUIREMENT <br /> , <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITI_E PRINCIPAL EXECUTIVE OFFICER 1 nay ° ee pen' ty' bw that thh dorumenl and all altachment, weft TELEPHONE DAT <br /> <br />prepared under my direetlon or super.Mon In ac- once with a system dedtned E <br /> to care that qu*Htled personnel properly gather and evaluate the Information <br />. aubmllted. bawd on my Inquiry of the person a persons -ho manage the sy l,m, <br /> or those pen dlrertly mspcmibk for gathering the Informations the information <br />. submltled K to the best or my Itnowlydge and beW. true, areursle. and complete. - <br /> I am aware that there are dgnlflcant penalties for submltttng fakw information. SIGNATURE OF PRINCIPAL EXECUTIW <br />OR PRINTED InrhWint the possibility of line and Imprisonment For knowing Oolauon& OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />t, %jrvi v-iv to nnv t_r.r ..r... r....,..... ..... .....- tr,wrwr wriua, wrr wn.wa.rrrrr.rna rrwrap <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-part for-in. PAGE OF