ADEM Form 515 "Monthly Discharge Monitoring Report (Dmr)" - Alabama

What Is ADEM Form 515?

This is a legal form that was released by the Alabama Department of Environmental Management - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2006;
  • The latest edition provided by the Alabama Department of Environmental Management;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of ADEM Form 515 by clicking the link below or browse more documents and templates provided by the Alabama Department of Environmental Management.

ADVERTISEMENT
ADVERTISEMENT

Download ADEM Form 515 "Monthly Discharge Monitoring Report (Dmr)" - Alabama

Download PDF

Fill PDF online

Rate (4.3 / 5) 67 votes
Page background image
State of Alabama Department of Environmental Management Monthly Discharge Monitoring Report (DMR)
PERMITTEE NAME:
PERMIT NUMBER:
COUNTY:
DISCHARGE NUMBER:
NO DISCHARGE FROM SITE : ( )
MAILING ADDRESS:
FACILITY:
LOCATION:
Monitoring Period:________________to___________________
,
Parameter
Quantity or Loading
Units
Quality or Concentration
Units No.
Frequency
Sample
Ex.
of
Type
Average
Maximum
Minimum
Average
Maximum
Analysis
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Name/Title of Principal
Signature of Principal
Telephone No
Date (MM/DD/YY)
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
Executive Officer Or Authorized
Executive Officer Or
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
Agent
Authorized Agent
of the person or 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 penalities for
submitting false information, including the possibility of fine and imprisonment for knowing violations.
When completed mail this report to: Alabama Department of Environmental Management, Post Office Box 301463, Montgomery, AL 36130-1463
Page 1
ADEM Form 515 11/06
State of Alabama Department of Environmental Management Monthly Discharge Monitoring Report (DMR)
PERMITTEE NAME:
PERMIT NUMBER:
COUNTY:
DISCHARGE NUMBER:
NO DISCHARGE FROM SITE : ( )
MAILING ADDRESS:
FACILITY:
LOCATION:
Monitoring Period:________________to___________________
,
Parameter
Quantity or Loading
Units
Quality or Concentration
Units No.
Frequency
Sample
Ex.
of
Type
Average
Maximum
Minimum
Average
Maximum
Analysis
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Sample
Measurement
Permit
Requirement
Name/Title of Principal
Signature of Principal
Telephone No
Date (MM/DD/YY)
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
Executive Officer Or Authorized
Executive Officer Or
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
Agent
Authorized Agent
of the person or 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 penalities for
submitting false information, including the possibility of fine and imprisonment for knowing violations.
When completed mail this report to: Alabama Department of Environmental Management, Post Office Box 301463, Montgomery, AL 36130-1463
Page 1
ADEM Form 515 11/06