Laserfiche WebLink
PERMITTEE NAME/ADDRESS 4nclude Fotili(v \umr l,rrn!inn rt It:)"/runt <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <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. 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 <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 e- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrtiri under penalt% uriaw that ihi%dravmenl and all attachments wear <br />d <br />d <br />di <br />i <br />i TELEPHONE DATE <br /> prepare <br />on rrr up-i%ion <br />un <br />er m. <br />rect <br />n accordance with a c}.dem dedRned <br /> hr a%surr that,inaliried perwmnel properi% gather and rt alunte the information <br /> .ubmiueal. F1 1-d on - imptin d the 1r on or per-ns who manage the %" tem. <br /> or three penonc direvt4 r fxmn ible for gathering the information, the information <br /> ,uhmitted i%, to the Iari or m% knowledge and twlief, true, accurate, and complete. <br />I am aware that them am %i <br />nifcant <br />enalth, rar.uhmittin <br />fal. information SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED g <br />p <br />g <br />. <br />including the Prmibilih of 6ne and imprim,nment far kttowinR ?iolalion. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY <br />(Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used This i5 a 4-part forth.