Laserfiche WebLink
PERMITTEE NAME/ADDRESS (7-" ForMtyNaw?La aria 1/D(Irwt) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDES) <br />NAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS <br />BOX PERMIT NUMBER DISCHARGE NUMBER <br />?G <br />FACILITY PER Mii•.,L_ MONITORING PERIOD <br />DAY <br />LOCATION -G C O FROM YEAR MO, I - TO YEAR MO DAY <br />, MOND G. DU BOIS, PRES/G - <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR •JC ) <br />F - FINAL MOFA 1 <br />DISCHARGE T.3 SAGE CREEK <br />;RGE z <br />NOTE: Reed Inetructiorw before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF FSA M PLE <br /> <br />PE <br /> ANALYSIS Y <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L r.A <br /> REQUIREMENT MINIMUM MAXIMUM <br />;.7 _ SAMPLE , . <br /> MEASUREMENT <br /> <br /> PERMIT .: IF _ r >_ <br /> REQUIREMENT - JI V- AtYt-T LALL'Y MIX MINT <br />- SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT I PIS T "IA X GENT <br />t I. '. SAMPLE j s . <br />A MEASUREMENT I f .. <br /> <br /> PERMIT <br /> REQUIREMENT DA AV, LA 17MX <br /> SAMPLE <br />_. _ . L MEASUREMENT - <br />5 1 _ PERMIT « { i- <br />FNl GRU REQUIREMENT -GJDA AV,,' f-: MX <br />10 71 F At- ' SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT :. r > 71-7 <br />_ . , REQUIREMENT MAX <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REOUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 ter"ly Y penalty Maw that this d cement and dr attachments were TELEPHONE <br />l <br />d <br />i <br />l <br />l DATE <br />rert <br />on or superv <br />prepared rn <br />rr my d <br />s <br />n In accordance with a system darned <br />h <br />/ to a> re that qua <br />rkd personnel properly gather and evaluate the Inf-matlon <br />A aobmIlted. Bawd " my inquiry o! the pevwn or prrsona who manage the systna, r <br />-- <br />or than perm a dlrectiy -,polelbk for gathering the lnrarmattoa• the Inrormation r - L- <br />r <br />k <br />l <br />now <br />whmltled Is. to the Sat o <br />my <br />edge and belief, tree, aommie, and complete. <br />1 am aware that thrre are cl <br />nin-t <br />enattin r- n,n•„un„ <br />SIGNATURE OF PRINCIPAL EXECVTTVIE <br />row ,?ror.,• <br />.u? <br /> <br />' <br />TYPED OR PRINTED l <br />p <br />r <br />. <br />,.. <br />1 -1.d..g th, paWh(M, r n,,. aN r,,, ?..;,r t-- OFFICER OR AUTHORIZED AGENT J A ODE WMMg YEAR MO OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IR•%r•nce ell attachments here) <br />[FABLE SOLIDS LIMIT APRLIFO FOR <"=10YR- 24NR PRE' <br />MONITORING - 1. I3 t= - - <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. T?Tr SiSj4 p4;J,,F4rm. PAGE jOf/