Laserfiche WebLink
PERMITTEE NAME/ADDRESS pnr",11'.e+M4Newite LArwtaw (/D(aeeeM) NATIONAL DISCHARGE MONITORING REPORT /DMRIPOES) <br />NAME _ <br />ADDRESS - <br />PERMIT NUMBER DISCHMIGE NUMBER <br />0. BOX y::, <br />`4 MONITORING PERIOD <br />FACILITY C.f!c YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />OMB Nor2040-0004 <br />MINOR <br />(SUBR DW) <br />F - FINAL GRFI <br />SEDT POND DSCHRG TO E SALT CR. <br />NOTE! Read kntructione before cdmpleting this tam. <br /> NO NCY <br />?E SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />. <br />EX <br />OF <br />ANALYSIS <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> <br /> MEASUREMENT <br />aTT <br /> PERMIT <br />REQUIREMENT it# ?+#? ###z b <br />MI1•4IMUill #it# 9. 0 <br />MAX r1UM <br /> SAMPLE <br /> MEASUREMENT <br />' <br />i;.), <br />='NfaD <br /> 7 f ;:?<llSt =a5 : <br />7 <br /> PERMIT rgI? <br />##T: - ODA A' DAILY Mx <br />h1'. : " I <br />?? REQUIREMENT i <br />:.E SAMPLE <br />NT <br /> MEASUREME ' REPORT 1i`.EJ GRAB <br /> PERMIT ## : ## #####tf i ##iEtE# r #iE### <br />: DAILY MX MONT <br /> REQUIREMENT <br /> SAMPLE <br />ENT <br /> MEASUREM 7000 Nf; E <br /> PERMIT P > <br />A <br />^ DAILY MX MONT1- <br /> REQUIREMENT -. <br /> SAMPLE <br />REMENT <br />S <br /> MEA <br />U ; 10 f. :. D <br /> PERMIT #9t•k•t!#?- -'t?? - ', , <br />.: p r•:: - <br />t <br />INST MAX <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> <br />? I{1:. f, i 1•?.t.: <br />t'I?## f. ?[ <br />.'C SA'N'#7f' <br />- <br />r ?'? <br /> f <br />R <br />' '011T _ o <br />r-;0 i 0 <br />= PERMIT <br />REQUIREMENT r1 <br />! <br />• 0DA Ak. '•. i'1 x <br />., NT SRI]-:: <br />I SAMPLE f <br /> SUREMENT <br />E <br />L M <br />A ..:. ??1•th ? ??`# ' <br /> PERMIT •It## # ,ti ?--•3; ##•? <. <br /> REQUIREMENT <br />lb <br />h <br />11 <br />nts were <br />TELEPHON <br />E <br />D <br />ATE <br />NAME/TITLE PRINCIPAL EXECUTIVE t "n.ty <br />OFFICER prepare u er pone ty n law that t <br />d under my dlrenlon or su <br />nai <br />fi <br />d e <br />r <br />his 6-1 end . <br />penhlon In accord. a with <br />ather and evaluele <br />ro <br />ert me <br />a system dalgrw <br />the Information d <br />- to amor ptnon <br />p <br />e that quali <br />e <br />of <br />I <br />l y g <br />p <br />enone who <br />ersoa or <br />th menage the sy0c m. <br />G l <br />- _ <br />?' <br />- submitt ry <br />rpu <br />ed. Bened on my <br />oredbi <br />llr res <br />e <br />dl e p <br />p <br />e for gathering the Informat <br />ion, the Informat <br />ion r?_? 7 <br />1 or Ihoa p <br />r <br />c <br />e pernes <br />kno <br />bpi of m <br />d K t <br />th wledge and belief, true, accu rate, and mmpk le. L ' <br /> submitt y <br />e <br />o <br />e I <br />ti <br />f SIGN ATURE <br />O Of pRMICIrAI EXECUTIVE <br />EXE <br />CUTI AR EA <br />- / t r--1. 1 a-.w .re that them are slgdfken l penalrles for aabmllting fa orma <br />on. <br />lse <br />n <br />L <br />OF <br />AUTHORIZE <br />FICER <br />AGENT <br />D <br />CO NUMBE <br />DE R YEAR M O DAY <br />TYPED OR PR TED Ind dict a the pr.siihl!!!, .1 11- end Impnsonrnt for knowing vWsL <br />onf <br /> r eItnu c rn-11 .rra ?hm?n/e hlrll <br />COMMENTS AND EXPLANA I IVn Vr nr. r -•-••-- -•• -- xFjP i , <br />SETTLEABLE SOLIDS LIMITS APPLI=' <br />i. c:. T r.• F1,'FNT- Pt ?- I _- <br />- This is a 4-pan form PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used