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<br />PERMITTEE NAME/ADDRESS Qnrludc Facilin•NafielG¢agon jDiffrrenr) - ~ ~ NATION!{L,Q,OLLUTpNT DISCHAR.C~EEL9MINATIONS'LSL~M /NPD,EB) - ~. FOfRl Approved.'
<br />NAME
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<br />,f01L dlrIrG: DISCHARGE MONITORING REPORT .jOMR ..
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<br />Elj-rCfi OMB,NO. 20400004
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<br />P.D• AOII 176 ~ ~ ~ PERMIT NUMBER DISCHARGE NUMBER . F ~ -I F~(L ECUYI
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<br />FACILITY OAR CHEEr CO E}OY67 ~ ~ MONITORING PERIOD. - SUAIfiCE FAr6FF TC TfiC L'I'TEEFr
<br />LOCATION - Y R 0 DAY YEAR - MO DAY ~ ~~
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<br />NOTE: Read Instructions before completing this form.
<br /> (3 Cerd Ony) QUANTITY OR LOADING ~ j<Cartl Onry) QUANTITY OR CONCENTRATION NO. FREQUENC SAMPLE
<br /> PARAMETER ~ (4G53) (5C•67) (38-45) (46-53) (54-67) EX OF TYPE
<br /> l32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />fsz~av ANALYSIS
<br />(64-68) -
<br />(69-70)
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<br />MEASUREMENT
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<br />ELDBNT GROSS YAI;O['
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<br />`"~' OT$~TLALLI DISSOyYCt
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<br />BPILUBtlT GROSS ifiLOE~
<br />NAME/TITLE PRINCIPAL EXECUTVE OFI
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<br />~ - _ YOSSI~IL1i Y OF FlNt AND IMYHISUNMEPfr. Shh 19 U.S.G. 91 W1 ARU 33 U.S.G f SIGNATURE'OF PRINCIPAL EXECUTIVE ~'ji D-YO.'!
<br />§ ]31 e. (Penalties antler these areMea may include lines Jp ro f/0,000 end or I OFFICER OR AUTHORIZED AGENT R
<br />TYPED OR PRINTED l ~ maximum tmpdsonment of belween6monlhs end Syaen;.) __ cone NUMBER YEAR MO ~ DAY
<br />~OOMMENTS AND EXPLANATION OF ANY VIpLATIONS (Re/erence all attachments here) ? '
<br />TSS AND TOTI~.,;,IROr (rrFTS WILL $E NAIIED, ACID SE"j7IE•8Lfi SDLIDS LIlIIT APPLIEL FCE <= 1CYE, i4h6 BEECIF
<br />~YENT SEE X'~'1.2~ F. ~.i TQr D$,~1ILS±. ,QgTRLI SArFLI11G IrSTBUCTICb`- - SEE I.C.9, F. Jllll.
<br />- EPA Form 3320.7 (08-95) ~1Fevtous eddtofis+t;1~$~~RQf^be Used, ~ -; T• `*{AEPJ,d,GfiS EP7~ FORM T-40 WNICH MAY NOT BE USED.) C 0 i 6 9 / C C C l 1 1 - j E 2 ~ PAGE OF
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