Laserfiche WebLink
PERMITTEE NAME/ADDRESS ditclade Fariliq Namelloratiun ijlNfferenti <br />NAME <br />ADDRESS <br />FACILITY i. r <br />LOCATION E <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 20,10-0004 <br />RDUT-f <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r?f r t x- .. ,.. r i_ i <br /> REQUIREMENT MF, (`.! T r ! <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certih under Penalth of haw that thi, d,rumem and all attachment, were <br />d _ <br />-- '- TELEPHONE DATE <br /> Prepared under m? dim limn or,ijwr%mon in accordance with a -Irm drsignr -??.- <br />r <br />t to asurt• that tlualiried prsoourd p uperl% Rather and esaluate the information <br />submitted. Rased on m% mquir) 4 the pe-n or pervms who manage the stem. <br /> or [how W-ris dirmtll n-.p nsible for gathering the information. the inF.rmatiun <br /> and com <br />lete <br />s knowl <br />e a <br />d h <br />li <br />f <br />true <br />accurnb- <br />d <br />i <br />d <br />h <br />l <br />t <br />l <br /> . <br />, <br />p <br />e <br />g <br />n <br />e <br />e <br />. <br />wthm <br />ll <br />n, to t <br />e <br />en <br />n <br />m SIGNATURE OF PRINCIPAL EXECUTIVE - <br />TYPED OR PRINTED Iann. aware that [here arc .ignificam penalties far whmitling fake information. <br />siadatiort. <br />inLduding [he p»sihilily ,f fine and imprnunment for knowing OFFICER OR AUTHORIZED AGENT <br /> <br />I AREA <br /> <br /> <br />NUMBER <br />CODE <br /> <br /> <br />EAR <br /> <br /> <br />O <br /> <br /> <br />AY <br />COMMEN I1 ANU "PLANA I IUN OF ANY VIOLA I IUNJ (Hererence air anacnrnerns nercl <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />4 FOR REQUIREMFN7 <br />,t - ni% is a d- ait fomi. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. - - p