Laserfiche WebLink
ERMITTEE NAME/--DRESS (Include NATIONAL POLLUTAN ISCHARGE ELIMINATION SYSTEM(NPDES) corm Approved <br /> acilityNarr:e(Locati, ferent) DISCHARI ONITORING REPORT ILIMR/ MBNo.2040-0004 <br /> TAME ; - 1 _ 2-1 17-19 - , <br /> —_ ---------_ pprovo.expires 9-30-85 <br />,blYRE3tS 1' i� :i <br /> PERMIT NUMBER DISCHARGE NUMBER <br />----�=T------------- MONITORING PERIOD <br /> I <br />'ACILIX ' + . <br />-- T----�i i-------------- YEAR MO DAY YEAR MO DAY <br />.00ATION ! FROM TO <br /> I i <br /> (20-21) (22-23) (24-25) (26.27) (28.29) 130-31J NOTE: Read instructions before completing this form. <br /> 1 (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER ' 46.53 NO FREQUENCY SAMPLE <br /> (32.37) I ( ) (54-61J (3845J (46-53) (54-61J Ex gNAOF <br /> Lvsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64-68) (69-70) <br /> SAMPLE <br /> MEASUREMENT <br /> I PERMIT , i., <br /> '. .. i-• . a n 4 y �°�:;`� r6 i., k• r +iY .. t.t..b <br /> 1 i I , REQut}�2EMENT ., <br /> ` T l •t 14- L SAMPLE - - - <br /> I ; MEASUREMENT <br /> PERMIT <br /> REOVI i <br /> ,- SAMPLE - <br /> MEASUREMENT - <br /> PERMIT <br /> REOVIRa=M ENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERM)T + • '•i, .;. �,, d' x <br /> REQUIREMENT " •. ✓,�. c, e <br /> •• ,- _ - - SAMPLE - - <br /> MEASUREMENT <br /> PERMIT <br /> .{ REQUIREMENT ,. .. - 4 <br /> . : SAMPLE <br /> MEASUREMENT - - <br /> ( I L f <br /> PERMIY` ,. .�,. . , ,:,Y5% .. ��xts 8 •."� '� h.. $y t. J` y-A., <br /> REQUIREMENT <br /> i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT m - - <br /> REQUIREMENT - «.s y .y,�y. >. ub '+L .,,. ° •X.st'„-; i>` , �i+ ;,,, .. , t <br /> AME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OP LAW THAT I HAVE PERSONALLY EXAMINEO TELEPHONE D A T E <br /> AND AM PAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> ON My INQUIRY OP THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> DST A ININO THE INPORMATION, 1 BELIEVE THE SUBMITTED INFORMATION <br /> IS TRUE, ACCURATE AND COMPLRTE, 1 AM AWARE THAT THERE ARE SIO- ' <br /> N IPICANT rENALTIE/ POR SUSMITTINO FALSE INFORMATION, IN CLUDINO <br /> DP PINE AND IM PR ISONM HN T, SEE n u.s.C. I, Io N. SIGN ATUPiE OF PRINCIPAL EXECUTIVE <br /> as..S.C. g 1 a1a. (Penalties under these statutes may include fines up to$10,000 <br /> TYPED OR PRINTED and/or maximum imprisonment ofbetween 6 month T and 5 years/ OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> CODE <br />:)MMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> PA Form 3320-1 (Rev. 10-79) PREVIOUS EDITION TO BE USED ( ;gPL CC L?r, T 40 .:'IIC'- MAY NOT BE- USC D.j <br /> o:= <br /> UNTIL SUPPLY IS EXHAUSTED. ' <br />