Laserfiche WebLink
FERMRTEE NAMEIADDRESS(IwrrdriatiMryNw?Laersow(/nlQi.nvj <br />NAME <br />ADDRESS <br />P E.*r c: <br />FACILITY ' 0 R N C RV. 'r L r. C R K M I P <br />. <br />LOCATION 7R SE r r? r? { G EXEC C. i <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEPA NPOES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER aSCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0-C4 <br />NOTE: Read kntrucdone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TrrLE PRINCIPAL EXECUTIVE OFFICER t cvrtrty under peon tf ° ow that thh doru Tent and dI ¦Itachments were <br />l <br />TELEPHONE <br />DATE <br /> R ared under m dtrecl <br />on or su <br />D D 7 perWlon In accordance w11A ¦ f7rlem designed <br /> to assure that qualifled personnel progeny gather and traluate the Inroenratton <br /> Submitted. Board on my Inquiry of the person or persona who manage the e"tem, <br /> or those persona directly responalbte for gathering the Information, the Information <br /> Submitted Is. to the bet of m7 knowledge and belief. Iraq, accurate, and complete. <br /> I am aware that there are signllleant penattles for eubmllling W. Information, SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED InchmUng the possibility a fine and Imprhonmenl ror knowing rlolatlorm OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMEN 1 5 AND EXPLANA 1 ION OF AN T vtULA I IONS (Ifoferenc1 M arracnmenrs herej <br />EPA Form 3320-1 (Rev- 3199) Previous editions may be used This is a 4-part fOrin. PAGE OF