Laserfiche WebLink
PERMrTTEE NAMEIADDRESS (7-&& Faro#yN..a/Lxanar up(p ,.o) <br />NAME 0-0 NATIONAL POLLUTANT OISCHAAOE ELIMINATION SYSTEM (NPOESI <br />DISCHARGE MONITORING REPORT (OMRI <br /> <br />ADDRESS p <br />BOA [ R <br />PERMIT NUMBER D <br /> <br />10 ISCHA <br />GE NUMBER <br />;1A 4il?ati. <br />FACILITY r 5 s: 11 :.y <br />W <br />f MONITORING PERIOD <br /> 04 ds YEAR MO DAY <br />YEAR MO DAY <br />LOCATION RSE 1 4 <br />0 F <br />ROM <br />14 TO <br />;IEL E. BEAR, PRESIL, <br />Form Approved. <br />OMB No 2040.0004 <br />(SUBF <br />F - f <br />RUNG <br />NOTE: Read lntstructiona b*fwe completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> 1>< OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT I MUM <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT !_ r -, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - Yi, OR <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t - -'EPA a : x r. r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />' <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I n"Illy under penalty low that thh doetrntent and it ¦il¦chments were TELEPHONE <br />l DATE <br />prepared under my d <br />reclbn or supenl>ton In ¦rcord¦nce with ¦ system designed <br />to assure that qualified personnel properly gather and -Juste the Information <br />submitted. Dowd on my Inquiry of the person or persons who manage the system, <br />or those persons directly renx nolbk for gathering the Info"Inati-% the Inft lion <br />submitted Is. to the best of my kn*wledge and beW, true, atcur¦te, and complete. . <br />' <br />' <br />I am aware that there are slgnlneant penalties for submfutng Islas Information <br />SIGNATURE OF ?RINCWAL EXECUTIVE "-- <br /> <br />TYPED OR PRINTED , <br />Inrhrding the Paadbliliy of fine and Imprisonment for knowing .lolotlota <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANA I WN VI- nn T V IVLA I IVNa rrn?erdnce, off •rracnmenrs nerel <br />- r:, T--AP: c-nL ?'1? [ ?;1j rr Ir)G.tt?Fri -I R, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This IS d 4-part form. PAGE OF