Laserfiche WebLink
PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME <br />ADDRESS ij <br />FACILITY - <br />1. i .... <br />LOCATION <br />Ai I T r. <br />PARAMETER <br />f I SO+.V .. <br />T5t 3 <br />A"t <br />:2 2 h <br />r <br />00z t`) 1. t {j <br />EMAI'41) (COD), <br />I C" I I <br />v'11,3VAL.. <br />NAMEITITLE PRINCIPAL EXECUTIVE <br />A/UTC, <br />t '. ?/? 1 ? l'1 t ? <br />TYPED OR PRINTED <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ? ((NPDES) OMB No. 2040-0004 <br />f <br />DISCHARGE MONITORING REPORT (DMR) rl flop <br />33 R F, ti <br />PERMIT NUMBER DISCHARGE NUMBER L ro a`Sr <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO "' t + r E?i {.; k' (:v r. r 1t if !f <br />NOTE: Read Instructions before completing this form. <br /> FREQUENCY <br />FREQUENCY SAMPLE <br /> QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br />EX OF <br />ANALYSIS <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />SAMPLE <br />MEASUREMENT <br />"r <br />PERMIT <br />REQUIREMENT :'•# 1. <br />SAMPLE <br />MEASUREMENT <br />PERMIT : <br />REQUIREMENT t 2i# iris## # # 3 9fz. iF f tt h °UC? <br />r. REPORT <br />DA I L' Y 111 1 b EE.K t_Y' V M F f. 5 <br /> <br />SAMPLE <br />NT } <br />MEASUREME " <br />PERMIT <br />REQUIREMENT ?• # t• fi: i S 3. :? t: d, t„#. r? W C <br />fE`(tif._s <br />SAMPLE <br />REMENT c 41 <br />F <br />MEASU ° <br />t te <br />PERMIT <br />REQUIREMENT t: •i~ t,:- #t ii # t, p...•i; ;f t li 3f ?•yr : 1z r vii (Jls <br />-13Ai z L Y M <br />l ;; ".... 1 <br />'.'t vl._ a <br />i _'I dI : <br />SAMPLE <br />MEASUREMENT 0211 # g>, a t ;..I,. s s it3 4. <br /> <br />PERMIT <br />REQUIREMENT ). C,3 <br />UAVG REPLM r <br />DAILY MX 3i # r €f#•tt i •F ° f3fiE€ 3# rcui-3: ? t .?? r LP) ?i:=Li 'I% <br />- <br />SAMPLE <br /> <br />MEASUREMENT <br /># 3i....#. <br />;;. .# :..t.#.?. <br />ii• 4.r._ <br /> <br />i <br /> <br />t <br />i <br /> c <br />= <br />f <br />` ' <br />t <br />PERMIT <br />REQUIREMENT #. 13t'if 3g•3 t1 s 3t ## ik +t#3t € i'it7 <br />G ?} <br />',t Y Iii tt <br />t <br />.l <br />,L . srli <br />w? <br />SAMPLE <br /> <br />MEASUREMENT -3£ -t.h<.,# tE <br />:i <br />S c? 4 <br />- :. <br />„'• f'x 3 <br />"`?.? is.y,g..gc?..t <br /> <br />PERMIT <br /> <br />REQUIREMENT #, °## 9k r.E' 't. .L. <br /> <br />C t, =s s11t x `t <br /> <br />v _ 31, # #.r t, •#•# T r 3a I i # r # : si <br /> <br />t: t v I• •.L <br />w <br />I, <br /> 1 certify under penalty of law that this document and all attachments were <br />? L TELEPHONE DATE <br />OFFICER <br />prepared under my direction or supervision in accordance with a system designed <br />J <br />t <br /> <br />} LfI 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 />ti <br />i <br />f <br /> <br />d <br /> orma <br />on <br />n <br />or those persons directly responsible for gathering the information, the <br />to the best of my knowledge and belief, true, accurate, and complete <br />submitted is <br />SIGNATURE OF PRINCIPAL EXECUTI q ?j t !3 <br />A ? 1?` ?? <br /> , <br />1 am aware that there are significant penalties for submitting false information, OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> including the possibility of fine and imprisonment for knowing violations. CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) 9 F. A C-11 E <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br />f3 p,, fay l *; R -E A ` S:'. <br />PAGE OF <br />' tr'_tL /ts:i? a 4 part,fprm. s