Laserfiche WebLink
PERMITTEE NAME/ADDRESS (T civ fw&tjN..WLl ewffon I/D(oG.w t) <br />NAME <br />ADDRESS ., W Y U :111`4:_ <br />Tr"''r;_ !iii HWfi,Y' <br />f,EF <br />FACILITY 'DltY 1 1-11 N <br />LOCATION ?•Ey <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (OMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAH MO DAY. <br />FROM TO <br />Form Approv!d <br />OMB No 20400004 <br />NOTE: Reed Inetructlorw before completing this tam. <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 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT I <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER 1 ""ay under Penalty o I.. ih.i this dorotnenl and all ¦n.chments ere <br />prep.red.rtder Ty dlrerllon or wper.tslon In .erord.nre »IIh . spfetn dalgned <br />TELEPHONE <br />DATE <br />TT to a„un that qu.nMd personnel P ri7 talker .nd e..ht.te the Inrnrm.lton <br />..btnltled. Bred en me Inquiry of the Person nr PerWnd ?ho etwrage the system, <br /> di <br />ibl <br />f <br />th <br />l <br />i <br />t <br /> y respom <br />he Information, the InforenalMn <br />or <br />ose pe wm <br />rect <br />e <br />or gather <br />ng <br />7? <br /> wbmllled b'. to the best of my kne»Ydge and beMrf. lrve..ccunle. and tornpkte. L? <br />- <br />.) L <br /> nlfteant <br />1 .m <br />.r' th <br />t the <br />a- <br />l <br />Nl <br />bmltli <br />r lnf <br />lb <br />f <br />l <br />b SIGNATURE OF PRINOWAL EXECUTIVE 1 <br /> re <br />s <br />g <br />pen. <br />es <br />or m <br />ng <br />a <br />orma <br />.» <br />a <br />o <br />n, ARE <br />TYPED OR PRINTED Including the possibility of nne.nd imprisonment for knowing Wallam OFFICER OR AUTHORIZED AGENT COOS NUMHER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference eN attachments here/ <br />-iR c?Rra^ I e L ,;FnlT I S Ct. a 7 M>r n !F- CI-AIM APPROVED E ; <br />DURDEN OF Pl; _IDT: <br />1 1 P <br />PAGE OF <br />EPA Form 33201 (Rev 3199) Previous editions may be used T?11a'pS'? 4 paT1`ftlrTn.