Laserfiche WebLink
,I?-HMITTEE NAME/ADDRESS Ilnelitdr. tt,riltro ` ,ne.QocwlontfD-tferenq <br />:;. M E <br />ADDRESS <br />FACILITY <br />':CATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY <br />FROM YEAR MO DAY <br />TO <br />Form Approved. <br />OMB No. 2040-0004 <br />k' <br /> <br />PARAMETER QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />I <br />NO. <br />FREDUENCY <br />SAMPLE <br /> OF <br />TYP <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS E <br /> SAMPLE <br />-• i . MEASUREMENT <br /> PERMIT <br />ski- t-;., REQUIREMENT I'ITJNT%; <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 />NAMEi'TITLE PRINCIPAL EXECUTIVE OFFICER I centt> under penalty of la" thin this document and all attachments wetc TELEPHONE DATE <br /> prepared under my direction or supen tsmn in accordance with a s% stem desiImed _ <br /> to assure that qualified per . onnei properly gather and c%aluate the mfxmauon <br /> submitted- Based on my trtuin of the <br />q petstm or persons who manage the cram. - . - rJ <br /> <br />- <br /> or those persons directly responsible for gathering the information. the information <br /> %uhmitied 1 i to the hest of my knoa)edge and helief. true. accurate. and complete. <br />t <br />I SIGNATURE OF PRINCIPAL EXECUTIVE - <br />` <br /> i <br />t Po_r • are significant perWtt - hmmttg false mtormation. + . <br />TYPED OR PRINTED h - htv of fine and tin smm + i :- knowing . iolattons. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />rnMMFNTC ANI] FYPI AMATInn1 AC Aa]v Alin] ATtnKiC 10-1- .., - -it .. F CODE DAY <br /> <br />EPA Forth 3320-1 (Rev. 3199) Previous editions may be used. This IS.a 3-part form.