This state form is to be used as a master copy from which the facility should make photocopies as needed. These should be mailed with the federal preprinted forms and the data should match.
Expired permits remain active until legally renewed, modified, or revoked.
Be sure to notify this office of any changes in company names, personnel, addresses, procedures, or treatment processes that may directly influence the discharge or sampling process. Within this outlined box should be the company name and address to which the MMR forms are to be mailed. If this address or name is wrong on the federal preprinted form please correct it on the form. Remember all correspondence with this office should include this number. The first two boxes have IN to indicate that it is a permit issued by the state of Indiana.