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Monthly Monitoring Report (MMR) For Industrial Discharge Permits 30530 - Indiana

Monthly Monitoring Report (MMR) For Industrial Discharge Permits Form. This is a Indiana form and can be used in Water Department Of Enviromental Management Statewide .
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MONTHLY MONITORING REPORT (MMR) FOR INDUSTRIAL DISCHARGE PERMITS Indiana Discharge Monitoring Report State Form 30530 (R2 / 8-07) FACILITY NAME AND ADDRESS: PLEASE COMPLETE AND SUBMIT ONE COPY EACH MONTH. THIS REPORT MUST BE POSTMARKED NO LATER THAN THE 28TH OF THE FOLLOWING MONTH. Mail To: Indiana Department of Environmental Management Office of Water Quality, Mail Code 65-42 100 North Senate Avenue Indianapolis, Indiana 46204-2251 Facility e-mail address: I N PERMIT NUMBER 0 0 OUTFALL NO. 0 MO. 8 Q C 1 0 8 YR. 01/1/08 Q C EFFLUENT CHARACTERISTICS EFFLUENT PARAMETER NUMBER SAMPLE TYPE Permit Condition Monitored FREQUENCY Permit Condition Monitored EFFLUENT Permit Minimum LIMITATIONS Permit Average Permit Maximum UNITS = Tue 1 Wed 2 Thu 3 Fri 4 Sat 5 Sun 6 Mon 7 Tue 8 Wed 9 Thu 10 Fri 11 Sat 12 Sun 13 Mon 14 Tue 15 Wed 16 Thu 17 Fri 18 Sat 19 Sun 20 Mon 21 Tue 22 Wed 23 Thu 24 Fri 25 Sat 26 Sun 27 Mon 28 Tue 29 Wed 30 Thu 31 MONTHLY AVERAGE HIGHEST VALUE LOWEST VALUE NO. OF TIMES WEEKLY, DAILY, MONTHLY FLOW Q pH C Q C MGD HI LOW LB/DAY MG/L LB/DAY MG/L LB/DAY MG/L EFFL. LIMITATIONS EXCEEDED TOTAL FLOW 0 Signature of Certified Operator I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly and evaluate the information submitted. Based on my inquiry of the persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Date (month, day, year ) Signature of principal executive officer or authorized Date (month, day, agent year ) Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com MONTHLY MONITORING REPORT (MMR) FOR INDUSTRIAL DISCHARGE PERMITS Indiana Discharge Monitoring Report 0 State Form 30530 (R2 / 8-07) FACILITY NAME AND ADDRESS: PLEASE COMPLETE AND SUBMIT ONE COPY EACH MONTH. THIS REPORT MUST BE POSTMARKED NO LATER THAN THE 28TH OF THE FOLLOWING MONTH. Mail To: Indiana Department of Environmental Management Office of Water Quality, Mail Code 65-42 100 North Senate Avenue Indianapolis, Indiana 46204-2251 I N PERMIT NUMBER 0 0 OUTFALL NO. C Q 0 MO. C 1 0 YR. Q 8 EFFLUENT CHARACTERISTICS Q EFFLUENT PARAMETER NUMBER SAMPLE TYPE Permit Condition Monitored FREQUENCY Permit Condition Monitored EFFLUENT Permit Minimum LIMITATIONS Permit Average Permit Maximum LB/DAY UNITS= Tue 1 Wed 2 Thu 3 Fri 4 Sat 5 Sun 6 Mon 7 Tue 8 Wed 9 Thu 10 Fri 11 Sat 12 Sun 13 Mon 14 Tue 15 Wed 16 Thu 17 Fri 18 Sat 19 Sun 20 Mon 21 Tue 22 Wed 23 Thu 24 Fri 25 Sat 26 Sun 27 Mon 28 Tue 29 Wed 30 Thu 31 MONTHLY AVERAGE HIGHEST VALUE LOWEST VALUE NO. OF TIMES WEEKLY, DAILY, MONTHLY C Q C MG/L LB/DAY MG/L LB/DAY MG/L LB/DAY MG/L EFFL. LIMITATIONS EXCEEDED Signature of Certified Operator I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Date (month, day, year ) Signature of principal executive officer or authorized Date (month, day, agent year ) Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com MONTHLY MONITORING REPORT (MMR) FOR INDUSTRIAL DISCHARGE PERMITS Indiana Discharge Monitoring Report State Form 30530 (R2 / 8-07) FACILITY NAME AND ADDRESS: PLEASE COMPLETE AND SUBMIT ONE COPY EACH MONTH. THIS REPORT MUST BE POSTMARKED NO LATER THAN THE 28TH OF THE FOLLOWING MONTH. Mail To: Indiana Department of Environmental Management Office of Water Quality, Mail Code 65-42 100 North Senate Avenue Indianapolis, Indiana 46204-2251 I N PERMIT NUMBER 0 0 OUTFALL NO. 0 MO. 1 0 YR. 8 EFFLUENT CHARACTERISTICS EFFLUENT PARAMETER NUMBER SAMPLE TYPE Permit Condition Monitored FREQUENCY Permit Condition Monitored EFFLUENT Permit Minimum LIMITATIONS Permit Average Permit Maximum UNITS= Tue 1 Wed 2 Thu 3 Fri 4 Sat 5 Sun 6 Mon 7 Tue 8 Wed 9 Thu 10 Fri 11 Sat 12 Sun 13 Mon 14 Tue 15 Wed 16 Thu 17 Fri 18 Sat 19 Sun 20 Mon 21 Tue 22 Wed 23 Thu 24 Fri 25 Sat 26 Sun 27 Mon 28 Tue 29 Wed 30 Thu 31 MONTHLY AVERAGE HIGHEST VALUE LOWEST VALUE NO. OF TIMES WEEKLY, DAILY, MONTHLY EFFL. LIMITATIONS EXCEEDED I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personne l properly gather and evaluate the information submitted. Based on my inquiry of the persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Signature of Certified Operator Date (month, day, year ) Signature of principal executive officer or authorized agent Date (month, day, year ) Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com
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