Laserfiche WebLink
PERMITTEE NAMEIADDRESS (include Farilin Namr;l urahon d Ngfrrrrf i NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />(S <br />F <br />Mw <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br /> <br />EX of <br />o <br /> <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 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I -(-f> under penally of law that this docuntetn and all attachments were <br />si <br />rc <br />nd u <br />d <br />r <br />di <br />di <br />r <br />c <br />rd <br />with <br />-i <br />d <br />i <br />i <br />i <br />d TELEPHONE DATE <br /> p <br />pa <br />n <br />e <br />m? <br />re <br />un o <br />wia r <br />s <br />on <br />n a <br />co <br />ance <br />a % <br />em <br />es <br />gne <br /> In assure that qualified personnel properl-s gather and esaluale the inrorntalion <br /> wbmilled. B:esed on my inquire- of the person or Pens %ho manage the system. <br /> or tho- Persons dire th rtspo-ible for gathenng the inrornlation, the information <br /> submitted is. to the best of mt knowledge and belief, true, accurate, and complete <br />1 am aware that them are si <br />nifkani <br />enaltito for submittin <br />false information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED p <br />g <br />, <br />g <br />miuding the famed thte of fine and imprisonment for knowing iodation, OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Heterence all attachments here) <br /> <br />EPA Form 3320-1 (Rev. 3,199) Previous editions may be used. This is a 4-part form.