Laserfiche WebLink
PERMITTEE NAM£lApORESS (InelairiaathryNaaa/Lorav,aw (/DIQGeueetJ NATIONAL POLLUTANT DtSCHAAOE ELIMINATION SYSTEM tNPOESI <br />NAME _ DISCHARGE MONITORING REPORT IDMRI <br />ADDRESS.. 9. _,-I:. .,i?. i`:. r•l.-i_. - Y <br />t' `1 I31-) X 53'> PERMIT NUMBER DI SCHAROENUMBER <br />-iERSE'T <br />MONITORING PERIOD <br />FACILITY !130 RN CRK. 9: F??LE'\ ?.;IZK MIRK.' <br />LOCATION. '__MERSET Y R O DA ?E6§ O D Y <br />C O C) FROM TO <br />.1AMES 'T. COOPER, EXEC V F` <br />Form Approved <br />M I I'v!Jri OMB No 2040-0004 <br />(SUBR MH) <br />E - FINAL <br />SURFACE RUNOFF TO HU130ARD C: <br />NOTE: Read Mstrvctiom before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> <br />EX of <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ? .., >s - . _ <br /> MEASUREMENT <br /> PERMIT :: ,r .-{ .; r ..... ... <br />VALUL_ REQUIREMENT MINIMUM MAX I MUM MONTH <br />... ...?. SAMPLE T _ <br />?;P ENDED MEASUREMENT <br /> <br />:30 7. C PERMIT > x -; - <br />-L_UENT GRC;:?' VALUE <br />- <br />- REQUIREMENT 30DA Ak,'(; MX 70 AV MONTI* <br />11 _,._ _ _ f;,-; - <br />1 SAMPLE <br /> MEASUREMENT <br />_. <br />. <br />_-.. ?. - PERMIT . <br />L <br />iDRCJSS REQUIREMENT .SODA AVG DAILY Mr. MONTH <br />... SAMPLE <br />AS FE i MEASUREMENT <br /> <br />C. O PERMIT r.. _ <br />-NT GP OSS VAL_U REQUIREMENT :30 DA A..' G I) A I L Y <br />-' MONTH <br />- <br /> SAMPLE t , - - - .. <br /> MEASUREMENT <br />S 1 4 I) PERMIT , - . <br />`-LUENT GROSS ';:' L-Jn- REQUIREMENT '? S" Z FIST IIAX :; . 6,EN <br /> SAMPLE <br />F-IRU f RrATMi:NT PLAN! MEASUREMENT <br />- <br />' <br />? 5U 1 C. D PERMIT OR <br />PEP 1 p <br />I LUENT GROSS VAL.U REQUIREMENT 30DA rHVC4 DAILY MX <br />14 <br />P - MONTH <br />_ SAMPLE 10 <br />7LV17 MEASUREMENT <br /> <br />- `) PERMIT <br />REQUIREMENT ` <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 fe^"' ° " pe"' tT ° Ian that thb dorumtnl and W atlachmrnlf were <br />Prepared under my direction or wpervWon In arrordanre with a sntem designed TELEPHONE <br />DATE <br />to enure that q°Wfied personnel properly ether and ..ah,ate the Inrnrmauo`" <br />wl,"Ited. seed - m, Inquiry (the Person ate per who manage tM yr,lem, <br />_ <br />es <br />onOble for <br />the tnformatloo <br />tht Inf <br />rmatio <br />th <br />dlrertl <br />atherin <br />' ' <br />I <br />t r <br />p <br />• ,. / <br />er <br />ou persona <br />g <br />g <br />, <br />o <br />n <br />l % r, <br />A" <br />l C?( <br />of m <br />kn <br />wbd <br />nd b <br />lief <br />I <br />a <br />nt <br />and <br />m <br />l <br />w <br />l <br /> <br />- <br />_ " <br />a, to the bet <br />? <br />o <br />ge a <br />e <br />. <br />nit. <br />n,r <br />e. <br />e <br />np <br />wbmitted <br />e <br />nlnrani <br />mbrdttin <br />tio <br />SIGNATURE OF PRINCWAL EXECUTNE <br />r <br />d <br />r <br />altle <br />f <br />rat <br />I <br />fo <br />I <br />h <br />h <br /> ¦m swan t <br />e <br />r <br />p <br />n <br />s <br />or <br />g <br />a <br />n <br />rma <br />n, <br />at t <br />en a AAFA <br />TYPED OR PRINTED Innudinr the pneelbtill) of fine and Imprisonment for knowing iolaumn OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS tRI/NInce off attachments hotel <br />I'S EABLE SOL ; Dc !_ MT APPLIED FOR !=1 n, ?4HR PRFC JP FVFNT-- <br />T r 17 I' P 4 <br />L: 17 f <br />EPA Form 3320-1 (Rev 3199) Precious editions may be used O;?()5' This is a 3-psn form. PAGE OF