Laserfiche WebLink
5 <br />PERMITTEE NAME/ADDRESS (Include Facilih Name/Location ifDierent) <br />NAME <br />ADDRESS 0--i 3 s R 'J ? t <br />I.?:,J? :. ,`) .... ? ? ; (3 Int. j. • ,:-'?'i. <br />FACILITY t_ .r t I trv is•?.' I. <br />LOCATIONC _rj-? ^{ t 1 u <br />s <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR t OMB No. 2040-0004 <br />F'771r'17 7, 771 F, I <br />PERMIT NUMrBER DISCHARGE NUMBER ) _ r 3s f. ' '•Uf <br />e13"f!<'t'F?.ir .I..Y `T i x lam: j !Tfi, F`? <br />MONITORING PERIOD _ <br />YEAR MO" DAY YEAH MQ_, DAY h „ t C , , w_ ; g , <br />FROM TO /X_ =s.,} <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF <br />S SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSI <br />- SAMPLE t ., :. <br />1 #? MEASUREMENT <br /> <br />Ill" +' . €' ;,j PERMIT <br />REQUIREMENT <br /> SAMPLE _ <br /> MEASUREMENT <br /> <br /> PERMIT o-- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE Y. <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> ervision in accordance with a system designed <br />direction or su <br />d <br />d <br /> <br />I'' C , V V I <br /> <br />F" p <br />prepare <br />un <br />er my <br />to assure that qualified personnel properly gather and evaluate the information <br />submitted. Based on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathering the information, the information <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br /> <br /> <br /> <br />EXECUTIVE <br />SIGNATURE OF PRINCIPA <br /> <br /> <br />f <br />7 /' / ( ? <br />, I am aware that there are significant penalties for submitting false information, THORhZED AGENT <br />F <br />R OR A <br />C AREA <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OF <br />I <br />E <br />U CODE NUMBER YEAR MO DAY <br />COMMENTS ANU L)LFLArvAI Ivry yr Aim T viuLAI ivrva lrtalarena:e an aua? ll...cxaa <br />f' ".. <br />i <br />=' <br />_ <br />r--v• <br />7 <br />' <br />'1: 't- )- t? 2 ;-1) <br />l <br />. <br />ti _ i..a <br />. x, <br />. <br />' <br />P <br />R <br />D <br />1 <br />...3 <br />? <br />? ZL, <br />€ jam-; 1 ? i ?{1? <br />x {- •, - _r"( <br />. <br />? tt ? 11 'I i -2,t._ ? j't? f - x a ,?.'• E { Y ?„I r., {'x{'? Tr r,? 1 y, ?-~ t {'S (:? I ! 2 { {»Ff ?rv. <br />{ <br />( <br />be used <br />3/99) Previous editions ma <br />R OD 2 _>: OFF S B 4;p2Itt?Olri]. PAGE . O0 <br />. <br />y <br />ev. <br />EPA Form 3320-1 ( • :? a .?:.,. _ ?._ .