Laserfiche WebLink
PERMITTEE NAME)ADDRESSpnrLfrFarttly Nws?Leraelan(/D($Wws) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT /DMR) <br />PERMIT NUMBER DISCHARGE NUMfIEN <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO. DAY <br />FROM TO <br />Form Approved ' <br />OMB No 2040-0004 <br />NOTE: Road Instrucdone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSES <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT rJ . f' i•.iri MA % t mi 4- i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />7D 911 <br />.. <br />:ji•1 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />?ti i. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />- SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />+°iR?i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT y <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />AMEMTLE PRINCIPAL EXECUTIVE OFFICER I cerlay -k, pe""! o •. that that docomenl and u ¦IitKhmmb were TELEPHONE DATE <br />N <br />prepared ender me dlrectfon or super Won In sevorditme with ¦ system designed <br />to court that queMM1ed personnel properly galhee and e•alusle the Information -- <br />"bmittrd. Based on my inqulr) of the Person or persons who manage the system, .-- <br />1 or these persons directly rnponsible roe gathering the Inrormatlon, the Information <br />aubmitted Is. to the best of my knowledge and belief, tree, accurate, and compkie. <br />SIONATLME OF PRINCIPAL FXFCUTr4V <br />' <br /> I am swan 111111 three an dgttlflcani Penalties <br />or tubmttting !sLw Information, <br />TYPED PRINTED 1nduAing the po.rbiuty of Arse and Imprisonment rer knowing .Iolsoo OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference 0 etfachmonfs harel <br />FI=Ji <br />?':VENT; <br /> <br /> <br /> <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used nis is 8 4-pan 1'OTIn. PAGE OF