Laserfiche WebLink
PERMITTEE NAME/ADDRESS (brclmic Fad din .Isaac-! mina t/!h/JerrnU <br />NAME <br />ADDRESS 1. <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 />YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> <br />MIN <br />Sul <br />NOTE. Read I ?structions befnre cmmnletino this form. <br />PARAMETER <br />QUANTITY OR LOADING <br />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 />f yf 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 r- r <br /> SAMPLE t <br /> MEASUREMENT <br /> PERMIT . ... !7 N ,r-, , . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. > CI.. ?_ 1•;?.Tt fJ <br />r *- REQUIREMENT !'If l ' T 1' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1-11% under penalty of law that flits document and all attachment were TELEPHONE DATE <br /> prepared under my direction ur supentmon m accordance with a system designed - .- <br /> to assure that qualified petso111101 properly gather and evaluate the information <br />- submitted Based on my inquiry of the person or per-ions who manage the system. <br />- <br /> or those perwru directly responsible for gathering the information. the infomteti.ni <br /> submitted is <br />It) the best of my knowledge and belief <br />true <br />and .omplac <br />accurate <br /> . <br />. <br />. <br />. <br />th <br />t ther <br />f <br />h <br />1 <br />fi <br />t <br />lti <br />f <br />i <br />l <br />o SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OP PRINTED am .aware <br />can <br />pena <br />or at <br />a <br />e are signi <br />es <br />m <br />nmg <br />se inf <br />rmation. <br />a <br />including the possibility of fine and unprisonmcnt for knowing :iolati-s <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />vv...... a...•v r+...+ ?... v.•.rar rvr• va rare a vava..rar rva?u I••c. c. c•.a.c ou auaaaannncuaa um c? <br />iR P) EC IF` SEE I ?.. Pr` FC?R r? r.rl11" •.1T•c <br />'-IONS - <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. fir This is 3 4-part form. PAGE OF