Laserfiche WebLink
PERMITTEE NAME/ADORESSQ.",F e+MryXm.!wLerrro LfDO6.t) <br />NAME <br />ADDRESS <br />FACILITY '3WYO i11NE <br />LOCATION '{ER CD 11 <br />L LY D. SANDER'; VP OF CIi <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM (/NPOESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHMOE NUMBER <br />MONITORING PERIOD <br />YEA MO DAY YE R D Y <br />FROM `1 TO <br />Form Approved. <br />OMB No 2040-0004 <br />NOTE: Read Instructions before compMUnp thle form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQ <br />U <br />NCY SAMPLE <br /> O <br />F <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE ) <br /> MEASUREMENT <br /> <br /> PERMIT <br /> <br />REQUIREMENT <br />-' ' ly ?. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> - <br /> SAMPLE ? -- <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> <br />NAME/TITLE PRINCIPAL CUTTVE OFFICER <br />n¦ ly o law that uke docntner,l and all attacnm <br />1 ""I" under pr <br />prepared under my direction or mpn.hlon In accorAsnre with a <br />enh were <br />s <br />stem desi <br />d <br /> <br />) TELEPHONE <br /> <br />DATE <br /> y <br />gne <br />t <br />M j <br /> <br />- 1171 ? o ft, m that q.a <br />fled personml property ether and e•aWate the Inro tl m <br />submitled. eased "my Inquiry of the person or permit, who nona <br />e the <br />t <br />/ <br />' <br />/ <br />?< ? ? <br /> <br />} r ! <br />7 <br />(-7t- /'W f i / ?c / i" ?l •' i ? ? 1-%f , ._- g <br />sys <br />em, <br />or than penom directly mpomlble for gathering the Informatiow, the information <br />wlbr <br />lll <br />d I <br />h <br />f <br />k 1, <br />I <br />! <br />• <br />! J _ <br /> <br />I <br />yy? <br />i? i f <br /> <br />I <br />-? <br /> <br />i <br /> n <br />t, to t <br />e <br />e beat o <br />my <br />nowledge and beMef, lroe, accurate. and .wnpkle. <br />I am aware that there are significant penalties for submitti <br />fak <br />Inf <br />SIGNAT <br />I , <br />rtl• <br />,. ' .. <br />/ ' <br /> <br />TYPED OR PRINTED <br />aae•ar1•e• aa.n evm auaTln?t AC auV \/1/v ng <br />er <br />orwution, <br />Including Ins po sibttlly or line and Imprisonment for knowing •taJsthnn <br />ATl^- ------- URE OF PR <br />NCWAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT AA <br />CODE NUMBER <br />YEAR <br />MO <br />J <br />DAY <br />4 HR ,• •`w w"`w °r w'r??"rrrr?"1J rr"' I5 GUAIMED, IF CLAIM APPROVED L I I ' PRIrCIP EVENT BY k:'iu <br />W r i_!._ ,. -rl ?j- Jet-t1ENT°?fr A 4, .,cL;t '•,f <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used - <br />rt'hi5 is 8 4 -parr form. PAGE OF