|
IIERMIRTFE NAMiJAOVRESS prad,><~rry>:~[..w+r. yOffwU
<br />NAME
<br />AOORESS - - ~ - _ _ "
<br />1 .•Ltl
<br />TACnm
<br />loc.,TTDN _ ~ k iil c!! t ~
<br />. .:,b ....:.dL Da L1'• LAISAvLh
<br />Nwnorwt ratv*Nrt nst7,Mp! nw~wAnw sverw NPDESI
<br />DtSCEUIROE MONRORB'10 REPORT lDA~RI
<br />PERMIT NUMBER nxrwlwcmAya
<br />MONRORING_ PERfOD
<br />YEAR MO DAY 'TEAR MO OAY
<br />ERDM _ ro
<br />rom+Appurl'.
<br />OAd ho :OaD0f7QA
<br />M
<br />NOTE: R•Ad krttuctlpw E•Itr• cornPl•Ifrfq IM• lorm.
<br />PARAMETER QUANTITY OR LOADING IX/ALRY OR CONCENTRATION NO. ~EO~Nr' SAMPLE
<br /> or
<br /> EX KV/9i TYPE
<br /> AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNRS aN
<br /> SAMPLE
<br />A
<br />R
<br />M
<br />'
<br />~ -
<br />-
<br /> SU
<br />ENT
<br />ME
<br />E ~ _ r
<br />.
<br />, _
<br /> _
<br />.. - PERMIT .• . • ~ ~ - , • 5 _ . .. , . F _ t / A's I'i'
<br />.. REQUIREMENT 1 ~! L Z !' ~: - i i "~ ^ '.i is
<br />. '`~ . ~ SAMPLE - __
<br />- /
<br /> MEASUREMENT
<br />I j
<br />
<br />'
<br />- - PERMIT _ .: e.. ..., - c... _ ~ _ . / - n F. 4
<br />.. ,.. REOUfgEMENT ; A .i { - :• T Y'
<br />- - - . - SAMPLE ~ J
<br /> MEASUREMENT
<br />
<br />' REOUIREMENT
<br />t A _
<br />-~ + . ~ SAMPLE _ ~ ---
<br /> MEASVREMENT '
<br />. PERMIT - ....
<br />-
<br />%
<br />
<br />„,_
<br />REQUIREMENT
<br />_ ,
<br /> SAMPLE
<br />1
<br /> MEASUREMENT -
<br /> PERMIT ' ' ,
<br />. REQVIREMENT
<br />~
<br />.
<br />- • . . .. - - SAMPLE _
<br />..
<br />. MEASUREMENT
<br />_
<br />.
<br /> - _ .. ~
<br />- .. . .. PERMIT .. _ . ~. Ii ~ ti .. i l' S .. '• ~ ' i i A:~ : i..
<br />L •' ~ , . .. REQUIREMENT
<br />_' ~ •r;, 1. n. ti ., .. : L l' "- 1:
<br />-_ - - -
<br />. _ _ ~ a t ..
<br />L , SAMPLE
<br />MEASUREMENT I
<br />_ ._ _ _ R , c
<br />_:
<br />~~::.. -
<br />MIT ..
<br />PE
<br />_
<br />_1 _nX~
<br />REQUIREMENT , „ , , : L : - ,
<br />NAME/TfTLE PRINCWAI EXECUTIVE OfTICER '"^'•• r 1.. e~eeh e`...,.....e ,a .n.•:..,n.....
<br />TfIEPRONE
<br />DATE
<br />r„p„e.y,,,,.mn„e,,,,,.,.,,.!M,w«...y.n...ya •,Iw....y..~
<br />r• rsw. nd M.•u,• p„w~1 -°P+•1 f•'M .N ..J••rr ti InnrwWi.n ~.
<br />wMrra •r•,~w,::gW+drv p..w,s M'+aw wM wawygr yv:w - .
<br />r 11'OY M~••~ Mn(Hr ,wF'NOM b' (Nle,4q W Idr.w•M EM 1/.r.y(,•O
<br />wYMr'M \ a W Yr d wr arr.Late a•a wM./. Irv,, wmw•..M.ewflrN.
<br />1 r •.r. ~ urn w• N'•k••+ f,..le,.. to ws.rw.a td. Id•.•rw. iIONATUIIE Of MINQ-Al fwECtRtVT - ' r
<br />TYPED OfI PRMED °"•'+°t'~P'~NN1dM•r •"alw.rw'.'.'r eo. l••.Mf .lere..r OfffCER OR AUtNOR11ED AO[NT 'l NUMEER YEAR MO DAV
<br />COMMENTS AND EXPLANA I I VN Vr wN • vI VlA 1 I VN5 lRNNMCI M AflicMlm!! hN.)
<br />EPA dam 520- !Rw Y9C7 Pr.vfou• Wloom may W uW Tn1S IS a.4 Vtm PAOf OE
<br />_ ~~. ,
<br />
|