Laserfiche WebLink
PERMITTEE NAME/ADDRESSf7mob.&FaeOry N..?L wootrl/D(Olie+.v) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />LI <br />NATIONAL POLLUTANT DISCHAAOE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ' <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read katruetloo before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX GF <br /> ANALrs<s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <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 />S <br />R <br />M <br />NT ti! )? <br />' <br />1 <br /> MEA <br />U <br />E <br />E - <br /> PERMIT <br />NT r n)?i j r rA (; <br /> REQUIREME <br /> <br />^ <br />I•. I TRE SAMPLE <br />MEASUREMENT <br /> <br /> <br />_ PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />document and all attachments were TELEPHONE <br />NAMEfnnE PRINCIPAL EXECUTIVE OFFICER t re " e ana o law that this <br />h DATE <br />W <br />lon In atcordante wfth llh . system designed <br />prepared YndH T] di RftlOn OI wper. <br />/ 1 h ` f to "noun that vueMfkd PerWsnne) Properll father end er Nvete IM Infornullon <br />I 1 <br />?? <br />submilled. seed on my Inquiry or th. Per>,nn a, prr who "n.ie the „stem. <br />/.t or those pe we dimfly reepon9bk for gathering the Infoematlon, the Information - <br />wbmlttd k to the best of . knowledge and belief. Ism. atcanle, and eomp4te. J <br />nln...t <br />1 am aware that Ihere are st <br />enalties for <br />b"ItI <br />fat <br />SIGNATURE OF PRINCIPAL EXECI)TIVIE <br />I <br />f <br />tl <br />? <br />TYPED OR PRINTED g <br />p <br />w <br />ng <br />s <br />n <br />onrr <br />on, <br />Inerrant the pnadbntty of tine and Imprisonment for knowing rlolatloom OFFICER OR AUTHORIZED AGENT AAEAJ <br />NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fR*/er*ncv ed effechmanfa horej ;gyp pREC iP EVENT JS CLAIMED. IF GLaliw APPRi t'J =:" pY Wu1GDr <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-part fonn. PAGE OF