Laserfiche WebLink
PERMITTEE NAMEIADDRESS 4m'ladr twilitr Na78N7Dfatlwl it Vi%frrnt! <br />NAME <br />ADDRESS <br />-(- 7- _ <br />FACILITY I M r`r t i , <br />LOCATION . <br />IT <br />?. <br />.. it ;rf=A82 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO I I L <br />Form Approved. <br />OMB No 2040 0004 <br />L:EL.T#0 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE I ;?^ a-q- -t > <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT . _ .: <br /> SAMPLE <br />1 <br /> MEASUREMENT f <br /> PERMIT # ;t-- - x,f st a M <br /> REQUIREMENT _ <br /> SAMPLE ?..., <br /> MEASUREMENT <br /> PERMIT <br /> <br />- -i IF REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ti .;..: p. .. .. t-: ji4TIN ,G. ., <br />• t. REQUIREMENT - -NT <br />!t T SAMPLE <br />PL- MEASUREMENT <br /> PERMIT Rti_PPr: i :}i iT It i ?.ORG <br /> REQUIREMENT VG r-c, T i { 1!x <br />l ?. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT LiVAl <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rrrtir, ender Iw•nau sine thin till, d,wnmanf and all auarhmrnP . aro- <br />A TELEPHONE DATE t <br /> p,rPA-d undor nth ch-ewat ur wlw•n ivnn in :lrcnrdanre w llh a ydrm 1-12n. <br /> <br />.. bnn.wlh:d lpudifil,f rw?r+wnml prnlw7lt catbar:md t,'Aunfr 1hr ifif m.ni'm <br />i! .uhmut,A. IW-d .m m? mqutr? or Ihr Iw nom or rw•r.on. if., mamt?r lilt +? Hrm. <br /> nr tho+r Iw•r.ou+dinrll? re+pmiblr for L!Ail inv. till- mlonuation, file informaW ai ?? <br /> <br />i +*ifilted i., to the 1-1.4 m? Anue Md¢e :nvl iw"lia. trot. arrur.nr. anI romplrn'. <br /> <br /> <br />F PRINCIPAL <br />EXECUTIVE <br />SIGNATURE •. -, 7 ' .. `l /) ^ /) [ <br /> I:unaenrethnllherrarr.n;odic:mtpemltie+L.r+uhmdunpLd+.inL.runUUm' <br />nnw <br />t rot An <br />re in <br />unlab m <br />i <br />ihili <br />f f <br />l in <br />rrv <br />i OFFICER OR <br />AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />D Y <br />TYPED OR PRINTED o <br />_ <br />ry o <br />ine :uu <br />q. <br />n <br />. <br />' <br />, Ill <br />nc the po>+ CODE <br />COMMENTS AND EXPLANA I IUN OF ANY VIULA I IUNS (rrererence an arracnmenfs nere/ <br />`?EtiIP EVENT SUrJEC i 1-0 13UkDEN OF PROOF REQUIREMENTS IN <br />,t j 1.'t. t :??r •. ; _U TO THE DI'JTSIuN WITHIN 4P HfIRS <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be us-ad 0006 , This-avt -r1-pwt i,c?rm.