Laserfiche WebLink
PERMITTEE NAME/ADDRESS(7-,&&F-OIY -bwlecarraw?AI$ 1) <br />NAME <br />ADDRESS - •J.T i <br />;1 Sl ?, " i= I?. <br />H 1;;HWAY 13 <br />E?()* R C <br />FACILITY OhlYO I^ <br />LOCATION KER <br />.-I I Y n c;AKJril=Z--,• VP OF <br />„ -p <br />DISCHARGE MCrt! i (_P!N6 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEA M DAY <br />13 FROM TO <br />. <br />C IL <br />Form Approved <br />OMB No 2040.0004 <br />MZt•-. <br />TAYLOR POND TO CFEEK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, iRECUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br />' <br />` PERMIT <br />t`l 1 ^: r MUM <br />MAXIMUM <br />._; = <br />l •„ '; REQUIREMENT <br />!L ??• SAMPLE n <br />` C <br /> j <br />'5U SPEr; MEASUREMENT <br />. PERMIT - ,. <br />• <br />' <br /> :?:) F1 AV:= i <br />r:'ti i ':_ r <br />x._z. LUti•1 ?RCJSS REQUIREMENT <br />_ . _ . ._ . _. r _ SAMPLE l VI / L ice' r <br /> MEASUREMENT <br />19 <br />4 <br /> <br /> <br />' <br />- <br />PERMIT <br /> <br />titter <br /> <br />;;i)i,;• - ;? REF <br />__ <br />i <br />i•i-? <br />Uri ?. L'r <br />. <br />:_? <br />UEN <br />f <br />REQUIREMENT <br />,-, `SAMPLE I (1 <br />-F.1_ R: t,OVE? MEASUREMENT p <br />- .•r?17 1 O PERMIT <br />4, V. <br /> <br />.. <br />- <br />r <br />' IJENT `=€20 REQUIREMENT <br />- <br />_ _ , .. SAMPLE N n <br />i` <br /> MEASUREMENT <br /> PERMIT r , i c:• r , <br />- <br />h : N i = REQUIREMENT <br />_;.. ' <br />' <br />' SAMPLE f <br />41_•W PLAN <br />'RU TRI^ATl MEASUREMENT <br />005 1 d Q PERMIT <br />` Hit i <br />t.. - F LUL-NT GROSS T REQUIREMEtJT _ •.JDA F <br />. = ' 1 <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAM !TITLE PRiNC L EXECUTIVE OFFICER ' "' " p`""y ° I•' that thh documanl and .11 ft-h;!;.13 .ere TELEPHONE <br />prep-'d sondes me dtrsctlorr or nrp-"if n In accordance Mith a :,.tern designed <br />? DATE <br />• r to Gage that qu.Nkd penonna property gather and *,.Joel, the Inf-oration i . <br />Basal Orr my Inqulry of the person M pereom who -.at, the system, <br />I I I / / , `i r r / submitted <br />'/ <br />/ ( <br />. <br />1 of thole person directlT resporntbk for gathering the Informatlon. the lnfnrm.tlml <br />• ! /, <br />r j <br />? F / Il f ! •?f r ?• / ? ?i fl I wDmltted is, to the best of my know4dge and Deihl, Inre, .cNnte, and tempklt. <br />SIGNATURE OF ?RINCNAL EXECUTIVE <br />1 <br />' <br /> i am.w.rs that them are sign!Bcant pm.let" for wbmllting War Inforn tlcm. All A <br />NUMBER <br />Y <br />TYPED OR PRINTED <br />Including the poadblllty of Bne and imp Uonmens W knowing Ioleumr> <br />OFFICER OR AUTHORIZED AGENT <br />CODE <br />EAR <br />MO <br />DAY <br />COMMENTS AND EXPLANA I ION OF ANY VIOLATIONS /Reforence&#arrechmontshrrel o?rFr•, G P:VENT !C; CLAIMED. 1F CLAIM APr'Rt71/E:I? I;Y WgCD• <br />hr-rll 1 T O CMG h Iii-: <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used