Laserfiche WebLink
PE RMITTEE NAMEIADDRESS, lnrlude Farilift \'arnrR nration if (li fferow <br />NAME <br />ADDRESS N <br />T. - I <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 3040 0004 <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 <br />7 7 <br /> REQUIREMENT <br /> SAMPLE - t <br /> MEASUREMENT <br /> PERMIT t ;; := t y p <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT x:..1 F rFd E'i - <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> <br /> SAMPLE <br />T HEP 1 rt; Pa-( H MEASUREMENT <br /> <br /> PERMIT i -- ^ T # r s- .t .• : ; <br /> REQUIREMENT , <br /> SAMPLE ?' - - <br /> MEASUREMENT <br /> <br /> PERMIT j A <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rerld. render Ixm:dn ..f Iu.. tlyd Ihi. A,evmaat :mA all anachmrnt• een' <br />" TELEPHONE DATE <br /> pn•pa-d amder ma Aira', Zinn or .ulw•rri.iun iu acennlaurr Hrth a .r.teni de.ienrd i <br />i ? ? <br /> ha.nl',' Ihut IIIIaI1rIWI lx'IVinnCf hrafx'(fa t:atha r :uul ea.duuta rhr infnrmatim " <br />' <br />i.G? ? f J )- ' YY I - auhmiual. ea.a•d nn m. inyuha .d the µ•n,ui or pa ram. nhn mwu,¢c Ihc.aac'u. ? <br />' <br /> nr Ihi..a• Ix•nou. Airea d} ra•.rym.iblr far ¢athe ring the iuformatiom Ih,' i 0--lion •? <br />I <br /> <br />O auhmilttid i,. In the hr+i of m) AnewledL'c and label. Irus, drrnrale, and rnmplrla. i <br />SIGNATURE OF PRINCIPAL EXECUTIVE r: " -- i'^'A?* i? , <br /> <br />I <br />umc Cd.e iuhrctn:nlrm. <br />prnaltie. I <br />I um uean• that Ihrni arc <br />FFI <br />R OR AUTHORIZED AGENT <br />TYPED OR PRINTED .I <br />.,. <br />in 1 id <br />rlurlint: the w,..ibdin.,f fina . id u n ......... 'm hn Annwin¢ r,nlunina. <br />f O <br />CE <br />DE NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />GUMMtNTS AND EXPLANATION OF ANY VIULAI IurvS (rrererence au arracnmenrs Here/ <br />.PECYP EVENT 5;ji?JECT TO OUkuEt:f OF PROOF RE13UIREP1r.N75 IN <br />TO THE L1 T v I -- C1N w : rH I N 419 HOUR ii. <br />PAGE <br />EPA Form 3320-1 (Rev 199) Previous editions may be used. ")Of This ty a,4-Puri Corm.