Laserfiche WebLink
PERWTTEE NAMEfADDRESS(Include NATIONAL POLLUTANT DISCHARGE ELEM9eATION SYSTEM 0~5) <br /> Faady Nama&ocation if different) DISCHARGE MONITORING REPORT WMR) <br /> NAME S etW )j P,1,� (2-16) (17-19) Form Approved. <br /> ADDRESS COO-=9 zdl 2 20 1Minor OMB No.2040-0004 <br /> NUMBERDISCHARGE U E Approval expires 10-01-94 <br /> F-Final <br /> MONITORING PERIOD <br /> LOCATION tAAti111t,I)Rif'IR/?'f 'A Z PASO ralV YEAR MMO DAY YEAR NO DAY =. NO DISCHARGE .r <br /> ATTENTION FROM O TO161 Of <br /> (20-21) (22-2) (24-M 26 (28-29) (3031) NOTE: Read IRatrucUone before complaUnp this form. <br /> FREQUENCY <br /> PARAMETER (3 Card Orly) QUANTITY OR LOADMKi (4 Card Only) QUALITY OR CONCENTRATION NO. OF SAMPLE <br /> (32-37) (46-53) (54.61) (36.4-N (46-s3) (54-01) EX MALY84 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS tsrvl (64-66) (69-70) <br /> SAMPLE *##*#* ****** *####* *****# #*###* <br /> MEASUREMENT #*##** *****# **#*#* S <br /> PERMIT *##*## **#### ##### 304)AYAVG <br /> REQUIREMENT #####9 ####*# ###### <br /> SAMPLE ****#* ***##* **#### ****** ****#* <br /> MEASUREMENT #**##* *****# ****#* <br /> PERMIT #*##** ** #** ####*# ##r*** 3"AY A O ####*# <br /> REQU"tEMENT #t#t>t ###t#k ###### <br /> SAMPLE #*#*** *****# #***** ****** ##*### <br /> MEASUREMENT * **# ****#* t***** <br /> PERMIT ###### #*#### ****** **##*# 304)AYAVG ####*# <br /> REQUIREMENT <br /> Mull" <br /> SAMPLE **#*#* ****** *##*#* **#*** **#*## <br /> MEA1SUREMI ENT ###*#* #****# ***#*# <br /> PERMIT #t#9## #*t# # *#tt#* #>r et#+� 30-DAY AVO *# #st <br /> REQUREMENT #####* ####*# ***#** <br /> SAMPLE ****** *****# *#*### ####*t ** *** <br /> MEASUREMENT #####* #*#### ***#** <br /> PERMIT ###### *##### ####*# #*# ## 3"AY AVG ###### <br /> REQUIREMENT ###**# ##* #* *#**** <br /> SAMPLE *****# ****#* *#**** *#*#** ****** <br /> MEASUREMENT #*###* *#**## *#***# <br /> PERMIT ###### ###*#* ####*# 30•DAYAVG ###### <br /> REQUREMENT *##** ##*### ****** <br /> SAMPLE ####** #*#**# **##*# ***#** **##** <br /> MEASUREMENT ****#* ***##* *###*# <br /> PERMIT #####* ###### ###### ###### =0"Y AVG ####*# <br /> REQUIItEiAEM #s#*#s *##### <br /> NAMEt1171E PRINCIPAL EXECUTIVE OFRCER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE <br /> Cf wr l l AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN:AND BASED ON MY <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION,i BELIEVE THE SUBMITTED INFORMATION M TRUE,RATE AND COMPLETE. I AM AWARE THAT THERE ARE SKNFICANT PEM <br /> ACCU �Q — <br /> �' FOR SUBMTTTING FALSE INFORMATION,INCLUDING THE POSSIBILITY OF FlNE -- /y 3�cj, //,� �/}/ /(� 20 <br /> AND IMPRISONMENT. SEE 1S U.S.C.5 1001 AND 33 U.S.C.11319. <br /> TYPED OR PRINTED (Pmn� under dross sh 4"my YUAg dnue*m up to S10,000•red or m., m TORE AL CUTIYE AREA <br /> � rr krfwtwnmav of bet~a moron Mo 5 yeere.) OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR NO DAY <br /> N© EV M-5 ©CCU&C-P "I LE uJF- uJ� &L -r#& SIT€ <br /> EPA FORM 3329-1(REV.9481 Pmvlous edWarm mry be teed 000051950315-1633 PAGE 2 OF 2 <br /> (REPLACES EPA FORM T-�0 WHICH MAY NOT BE USED) <br />