Laserfiche WebLink
PERMITTEE NAMEIADDRESS (Include Facility Name/Location if Different) <br />NAME ???• ,i.rrz? ryr_°: t:=trEr +•°? <br />ADDRESS ; ?! d 1 :Z Lti ?. P;i p L .l2=t <br /> <br /> <br />FACILITY X ... a,_ ,.T . . <br />' LOCATION n.A. <br /> <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 />trµ ?n <br />7:m T <br />NOTE. Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />' J. i SAMPLE ..: ;:.. r :. -...,. :... :< ..* <br /> MEASUREMENT <br /> PERMIT <br />r ti d - ?i . REQUIREMENT ;.. a <br />Yk <br />LL <br />" SAMPLE •. 1•. ?.. .., ri r- , ?M1 ?? <br />•+t r...r.i' i ,_ _ <br />sx.r MEASUREMENT , ice' t ?k1 ;i? <br />}. PERMIT <br />e t ¢ -:) c:_ _ REQUIREMENT r <br /> SAMPLE K ?. .. ., a'. .. . }: ,..: ?: r <br />y <br />t <br />..`s. _ MEASUREMENT I A `= I` <br />. . . PERMIT ?.•;, .< ? <br />,c <br />,; .. , .... <br />:.:_.. <br />... .•r ;?;' ,.- <br /> <br />x ni <br />ti t ?C:l l r z a t "2^ REQUIREMENT <br /> SAMPLE <br />r MEASUREMENT <br /> PERMIT <br />- r- • o , - REQUIREMENT % <br />- ?: <br />a r SAMPLE r? a+ _? ; i .. > t•: i' a ! / 2 rii?" <br />" <br />' <br />r <br />' MEASUREMENT <br />:i:.... ... <br />: <br />t <br />O- 3 <br /> PERMIT <br />t }l' e y _t w• terra d ,,n REQUIREMENT ;a »7 tygN, <br />zl_ <br />a- <br />l .. . <br />- •' ? <br />SAMPLE <br />`. MEASUREMENT <br /> <br />., PERMIT <br />,.. , ., -. <br />.. ..... - <br />`?.. ?. <br />r? .., . - <br />it <br />_ .. _ <br />+ <br />., tw <br />,d,- REQUIREMENT rr <br /> SAMPLE '•: 6'C w . ne 4 <br /> MEASUREMENT <br /> <br /> PERMIT n <br />•r _ <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were <br />d <br />d <br />di <br />ti <br />i <br />i <br />i <br />d <br />ith <br />t <br />d <br />i <br />d TELEPHONE DATE <br />/^ '0 +T a • -?' l.? t ance w <br />prepare <br />un <br />er my <br />rec <br />on or superv <br />s <br />on <br />n accor <br />a sys <br />em <br />es <br />gne <br />to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquiry of the person or persons who manage the system f <br /> , <br />or those persons directly responsible for gathering the information, the information ---?t ?- ,. ? ? " I C,? f ,f <br />" 6. ?,? <br />}} submitted is <br />to the best of my knowledge and belief <br />true <br />accurate <br />and complete. ?? <br /> , <br />, <br />, <br />, <br />I <br />th <br />t th <br />i <br />if <br />lti <br />f <br />b <br />itti <br />f <br />l <br />i <br />f <br />ti <br />t SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRIATED am aware <br />ere are s <br />gn <br />ican <br />pena <br />es <br />or su <br />m <br />ng <br />a <br />se <br />n <br />orma <br />on, <br />a <br />including the possibility of fine and imprisonment for knowing violations. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CO E <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br /> <br />,OF v <br />1>5 zS? 4 elf?rm. PAGE <br />s