Laserfiche WebLink
�PERMITTEE NAME/ADDRESS (Include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPDES) <br /> Facility Na?*LocatlonfjdifJerentf DISCHARGE MONITORING REPORT (DMR) <br /> N i --------------'----- 2-16 17.19 <br /> ADDR959 <br /> PERMIT NUMBER DISCHARGE NUMBER <br /> '------------ --- -- MONITORING PERIOD <br /> 1'ACI LI TY <br /> ------- ------ YEAR MO DAY I I YEAR MO DAY <br /> LOCATION FROM TO <br /> --------------------- <br /> (20-21) (22-23) (24-25) (26-27) (28.29) (30-31) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (5461) (38-45) (46-53) (54-61) NO. FREQOUFENCY SAMPLE <br /> (32-37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS>< 6263) (64-68) (69-70) <br /> SAMPLE <br /> MEASUREMENT <br /> PERWT <br /> REQUIREMENT - - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , ere t 4 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT �- <br /> r'EEQUIR£MENT J i 7 ,. <br /> SAMPLE <br /> MEASUREMENT <br /> i <br /> PERMIT ; <br /> ABQiJEIt£M£N'C � <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> R�d1EJIMtEMENT <br /> SAMPLE <br /> MEASUREMENT <br /> P#NtrtlT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> #LE�CItl111lEM ENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> r/ ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR l+'� <br /> )',�;. •" (' Pt d•+' �> /v OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG �- <br /> % NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> %l�'`;',,.�-/.�'•�'�'• THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 1B USC S 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 33 U S C 4 1 319 /Penalties under thew statutes may Include Imes up to E1a)(M) .-..� <br /> TYPED OR PRINTED and or manmum n,prlsunmvnl u(Artuwvn 6 month.and a war.s OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> EPA Form 3320-1 (Rev.9-88) Previous editions maybe used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />