Laserfiche WebLink
KAINITTEE NAME/ADDRESS(7*a.hs«woyA*owi anewttDos.n,Jp <br />NAME <br />ADDRESS <br />FACILITY C I-) <br />LOCATION :'?NDFRS. VP OF n <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESl <br />DISCHARGE MONITORING REPORT (QMR) <br />PERMIT NUMBER Esc-AAGE NUMBER <br />MONITORING PERIOD <br />Y 'M9 I D !4 1 <br />- <br />FROM <br />I TO re <br />1 -7 -4 <br />T ?1 Form Approved. <br />OMB No 2040-DO04 <br />NATC• R-A Ieaasnu eie e,. I..E......... t.•1.... •I.I. 1...... <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FRE OFNCY SAMPLE <br />- AVERAGE MAXIMUM UNITS. MINIMUM. AVgWE MAXIMUM... UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> P <br /> ERMIT <br />REQUIREMENT Ci <br /> SAMPLE <br />MEASUREMENT <br /> PER <br /> MIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT -- <br /> P <br /> ERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> P <br /> ERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT - - <br /> PERMIT <br /> REQUIREMENT <br />NA E/T1TLE PRINCIPAL EXECUTIVE OFFICER ' fe^'ty an"" p.n¦ ty n law n• th <br />prepared under my direction a-P k dommenl and au jtwh: <br />IN/on In accordan <br />e with a e;L, wen <br />t <br />d <br />TELEPHONE <br />DATE <br />\ <br />P -I c <br />sys <br />em <br />e.l=ned <br />to <br />n <br />n th <br />t <br />lifi <br />d <br />f 1 <br /> <br /> <br /> <br />! 1/ <br />r? : y' ?•???' i a <br />o <br />qua <br />a <br />e <br />personnel property gather and e,ahr¦le the Inro,,na/bn <br />or, <br />¦abtnltled. Bawd on my Ir q.lry orthe penal or person who manage the %,Item, <br />hone pcr directly relpon9ibk for gathering the lnfonnatlon, the lnrormadon <br />mbmllted I: <br />to the bert of m <br />knowled <br />d b <br />li <br />f <br /> <br /> <br /> <br />\: l' - <br />1 <br />` <br />` y <br />. <br />ge an <br />e <br />e <br />. troe, a nle. and complelt. <br />t •m .w..e lhu lnen .re dgnlnnnt pen.Ine ror abmltnng r.kw inrormatlon, SIGNATURE OF PRINCWAL EXECUTIVE ? <br />, <br />TYPED OR PRINTED <br /> <br /> <br />rOMMFNTS Alin FVPI ANATInN OF ANY VIOI Including the pon•iblilty or fine and Imprisonment for knowing ,laf.Uom <br /> <br /> <br />ATin",, ra.s...,... -m.ee.,r....... %--i OFFICER OR AUTHORIZED AGENT <br />ARE <br />OOS NUM ER <br />C <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />... •?. .?._ ..u. _a..v v..._ at _-a. v:z-.r .?z.nn r t•t--,. _r L. ': G.i+rl A? ... t.:t 1l"fC:1. 1T' 1. Lti11"1 r-:rrr?vv:=:,: l:'1 ?'?/?.31r :-Ir <br />TN?IV I_T1' AF PL 'Fi• Tn (7r'Pf1RrT--T MI A''l1F? MF-niTr f FF <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is a 4-part (OEEn. PAGE OF