Laserfiche WebLink
PERMITTEE NAME/ADDRESS (Include Facility Name /Location if Different) <br />44AME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR I MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040 -0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />>< <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NQ, <br />EX <br />FREQUENCY <br />OF <br />ANALYSIS <br />SAMPLE <br />TYPE <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />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 />if <br />€� <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 />NAME[TITLE PRINCIPAL EXECUTIVE OFFICER <br />I —tit% under penalty of law that this document and all attachments were <br />prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel properly gather and evaluate the information <br />TELEPHONE <br />DATE <br />�t � A <br />submitted. Based on my inquiry of the person or persons who manage the system, <br />'---- <br />or those persons directly responsible for gathering the information, the information' <br />submitted is, to the hest of my knowledge and belief, true, accurate, and complete. <br />I am aware that there are significant penalties for submitting false information, <br />including the possibility offine and imprisonment for knowing violations. <br />'^-- °L•'f'r �"~ <br />.. ,,., s _ . <br />it ,7 <br />4 <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED <br />AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />This is a 4-part form. PAGE OF <br />EPA Form 3320 -1 (Rev. 3/99) Previous editions may be used. � <br />