Laserfiche WebLink
FERMRTEE NAME/ADDRESSQwr66F.rrlrryN..WL. wi-(/D(Qwwa) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (/NPOES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />kJ. BOX 5Li' PERMIT NUMBER DISCHARGE NUMBER <br />1ItiERSET <br />MONITORING PERIOD <br />FACILITY ?NBORN CRK -L1-?, L;{r, f` IN-E- > YEAR MO DAY YEAR MO DAY <br />LOCATION 1MERSET CG FROM TO <br />JAMES T. COOPER, EXEC V. P <br />Form Approved <br />OMB No 2040-0004. <br />MINOR <br />( SUMP. MH ) <br />F - FINAL <br />SEDIMEPIT FOND TO HUBUTARD CRFi <br />NOTE: Read Inatructforn before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FRtO <br />U <br />NCY SAMPLE <br /> O <br />F <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE , <br /> MEASUREMENT _ - Y 1= <br /> PERMIT ###iF3F# = PORT ### ? . if#### ###### n - s: WC F: <br />k REQUIREMENT .:` <br />' T' MAX iil7t J T? <br />_ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER ' Ce"" y " ' ve"•'y ° 0-w that thh dorvment and W attach nwnls veers <br />TELEPHONE <br />DATE <br />prtpared under my direction or wprrH>1on In aecordante with system designed <br />- to risers that quoUrmd personnel properly gather and eraluale the Information <br />, !'.•:? <br />b <br />d <br />B <br />d <br />I <br />h <br />su <br />mitte <br />. <br />re <br />on my <br />nquiry of t <br />- <br />e person or persons who manage the system. <br />or thane <br />ersms directl <br />m <br />ondbl <br />f <br />th <br />I <br />i <br />th <br />f <br />h <br />p <br />y <br />p <br />e <br />or ga <br />er <br />ng <br />e <br />n <br />ormation, t <br />e Informaton <br />i submitted h <br />to the bat of my knowled <br />e and betlef <br />tr <br />ru <br />ate <br />and <br />kt <br />, <br />g <br />, <br />w. ar <br />r <br />. <br />romp <br />e. <br />I am were [hoe there am 5121,11k "I pen.ma For sabmildng rape Information <br />SIGNATURE OF PRINCNAL EXECUTIVE I <br />TYPED OR PRINTED . <br />Including the poodbulry or one ¦nd Imprisonment for knowing rtoiat?om OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO DAY <br />COMMtNTS AND LAMANA I Ivn yr ore T vlvLn I tvrva frfererence an arraenmonrs nerel <br />InLE ',O!_ TDO 1 MT APPLTED FOR =IOYP, 7, <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used c t 11S 1-4-part form. PAGE OF