Laserfiche WebLink
PERMITTEE NAME/ADDRESS,laidudr I at itire \unte!/atrarina if Differrntl <br />iDISCHARGE MONITORING REPORT (DMR) <br />NAME <br />ADDRESS ,L; _ h' • . `. <br />FACILITY m }_ ; i <br />LOCATION <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approveo <br />OMB No 2040 <br />DEL T P <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT -- I ;; <br /> SAMPLE <br />?. MEASUREMENT , / -., _• <br /> PERMIT i ?: + _ J rt ri i? <br />r <br />REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT rr <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -; <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT c c r. r _t. - <br /> REQUIREMENT <br /> SAMPLE i '-; <br /> MEASUREMENT <br /> PERMIT T FZ: ii : T _ .. ;.. <br />1, t <br />c REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMErfITLE PRINCIPAL EXECUTIVE OFFICER I rrrtif, undrr IN•M1all, n h,, Thal Ihi. dlNUmrnl and au auaahmem. Nr'n <br />Nrth <br />.a <br />' <br />r <br />d <br />h <br />- di-ii <br />.. <br />. <br />.. i.i <br />in <br />c <br />da <br />le <br />tl-i <br />d f TELEPHONE DATE <br /> .. <br />.. <br />Nr <br />. <br />pn <br />pa <br />r <br />mat <br />r <br />. <br />.m <br />ac <br />nce <br />a <br />m <br />gm <br /> <br />-^ <br /> <br />t <br />?'l IIrl7 w u. <br />.urr 111A quabf nl pcr. Nnn0 prnpa•rla xathrr and ra ahtau• <br />Ihv infornaation <br />. <br />- <br />- .ubmiltrd. Iia-l Nn ma inyulr. Nf Ihr 1N'AnM1 ur IN hNM Nhn nrnnoye the .adrm• <br /> m th..v IN r.nndinrlla rr+INNltible ba' ?,aherint; Uu• a1l-mati n. Its, informutinn <br /> <br />U .uhtnithd i., to thr 1-1 of m. kn-kdco and Ix•liai. Irnr. urruruu•. .Ind .mtplen•. <br /> <br />if <br />l <br />f <br />• i <br />I <br />h <br />d <br />i <br />f <br />t <br />l <br />f <br />i <br /> <br />SIGNATURE <br />OF PRINCIPAL <br />EXECUTIVE ., _ <br /> <br />.? "• f'. ! 7 <br />r Nmr arr . <br />);u <br />icant prnu <br />t <br />.a <br />nnnat <br />..n. <br />am :rear <br />t <br />Ga? <br />- <br />se <br />a <br />n <br />al OFFICER OR <br />AUTHORIZED AGENT AREA <br />TYPED OR PRINTED I- <br />Lra-i <br />I p <br />nn9udin it,, ....tbdua N( b <br />Gne and impria. omen! .r nt.Ninp aiNlati.m'' <br />it,, <br />J ODE NUMBER <br />C <br />YEAR <br />MO <br />DAY <br />GUMMENTS AND EXPLANAIIUN Ut- ANY VIULAIIUNS (Mererence an arracnmenis nere) <br />EC I F' EVENT S1JD JE:C T 1-0 BURDEN OF PROOF- REGU I REMEW S IN <br />i'D TO 'fHE DIVISION WITHIN 41-' =ir1)RS <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />EPA Form 3320-1 (Rev. 3!99) Previous editions may be used. t?QUe; rlti:.??1 T.1 F+vtlUrm.