Laserfiche WebLink
PERMITTEE NAMEIADORESS(JsaY4 Farfbry JY?sa tacart.s. I/D(Q1wwr) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <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 />NOTE: Read Irmtructione before completing We form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> EX ANAtys+i TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <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/77T1E PRINCIPAL EXECUTIVE OFFICER t certry " nd., prna y o law that thin documem and au atlarhmenb <br />TELEPHONE <br />DATE <br />prepared ands, my direction or supe..Wow In accordance with • system designed <br />to insure that g..NMd pervonnel props, y gather and r,Wuol, the Information <br />submitted. Baal ow my inquiry of tin person or persons who manafe the s.ttem. <br />or those <br />rreor. dirern <br />re <br />ewebk f <br />r <br />th <br />rin <br />th <br />I <br />f <br />t <br />p <br />y <br />p <br />o <br />fa <br />e <br />g <br />e <br />ormation, the <br />n <br />nformatkm <br />V submitted K to the bet of me knn.rkdge and belief, true. sorurste. and complete. <br />1 am swan that then are sl fdfkaat penattles for mbrnltring ratty Information <br />SIGNATURE OF PRINCNAL EXECIJTIYE <br />TYPED Oft PRINTED . <br />including the Possibility of fine and Imprisonment for knowing lolstkmm OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANA I IVN OF ANY YIVLA 1 IUN5 (Reference M attachments hare) <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-part form. PAGE OF