Report of Benchmark Monitoring Data for Storm Water Discharges Associated with Industrial Activity

Report of Benchmark Monitoring Data for Storm Water Discharges Associated with Industrial Activity under the TPDES Multi-Sector General Permit (TXR050000)Permit No. TXR05|_|_|_|_|, SIC code: |_|_|_|_| or Industrial Activity Code: |_|_|, Sector: ___ Check (T ) if 1st Period 2nd PeriodBenchmark Annual Average Annual Average Parameter Result Result Exceeds Level (mg/l) Result (mg/l)(Jan–Jun) (Jul –Dec) Benchmark LevelAs the operator/representative of this facility, 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 the inquiry 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 there are significant penalties for submitting false information, including the possibilit fine and imprisonment for knowing violations.Signature: Date: Instructions:¦ In the top right hand corner, be sure to fill out the permit identification number assigned to your facility. It will begin with “TXR05” and have 4 number or combination of letters/numbers that follow. If you do not know this number, look it up at http://www5.tceq.texas.gov/wq_dpa/index.cfm or contact us (see ...