Laserfiche WebLink
PERMrTTEE NAME/ADDRESSvndb••saroiyN wWL. ,wraw(rD(fF eI <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM /NPOESJ <br />DISCHARGE MONITORING REPORT (DMRI <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 instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> <br />ride r a°' iy ° law that this dor-,mem and .n.n.rhments -mr TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER i fir," y ° <br />DATE <br />prepared under my dimcllon a suprrv1 - In accord- with • syslerrr designed <br />. to .sure that qualified personnel Property [other and evaluate the Intormallon <br />* <br />- submllted. Booed on m 1 ul of the rson a <br />y na n n per,or„ who nonage the fyslefn, <br />or those persom direruy r pomlble for fathering the Informatim. the Information <br />^ <br />mbmilled to, to the best or my knowledge and belief, Imo. accurate, and complete- <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />l <br />t <br />1 <br />if <br />lt <br />f <br />i <br />I .- <br /> am swan that then .n s <br />gn <br />can <br />pena <br />ies <br />or subm <br />tting fate <br />nformation, <br />TYPED OR PRINTED Including the possibility of fine and Imprisonment for knowing vfolatlons OFFICER OR AUTHORIZED AGENT COOS NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# attachments hard <br />EPA Form 3320-1 (Rev- 3199) Previous editions may be used This is a 4-part form, PAGE OF