|
RERMITTEE NAMEIADDRESS pneL«V FwWgNr'lrnlew r/OfOb.wp
<br />NAME ScreF.L:A ~.:J4L c`. .:HV't
<br />ADDRESS i' • Lt • U O A t 7 U
<br />HAYCEN CC biu34
<br />FAaLm
<br />La%ATpNI!AT UEh CU :iiU j!!
<br />31fY: .;hcG,; YL.C:iLti. rE!:.;~AL ':duA,L;c
<br />NATIONAL POLLUTANT DISCNAROF E7IMINAl10N SY9TEM NPOESI
<br />DISCHARGE MONITORING REPORT (D Rl
<br />!noon I:,i a~3 i
<br />PERMIT NUMBER dsciiARDE NUAem
<br />•~~.~,.
<br />MONITORING PERIOD
<br />YEAR MO DAY !.. YEAR MO DAY
<br />..
<br />FROM 'V1 l.U Uy;{ TO Ui 11 Ji
<br />1i RJh
<br />(SUcn JC)
<br />F' - FI;JAL it~jUll
<br />~~I~CY.A'~G`. TU 9At;F C'i.eH
<br />~I NOTE: Reed Imwetl«r bwlof~ compbtlna thb 1«m.
<br />PARAMETER OUAN7ITY OR LOADING .
<br />~
<br />~` Quality or Concentration Np, FREDDENCV SAMPLE
<br />
<br />EX op
<br />
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />~ MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS ANALYae TYPE
<br />J1L r.Y:} ~HLA`'G SAMPLE :t :iP47R ~ ,}y) qop R4+pA 'F4=k r,: rk :: .. :'=r
<br />Y I S J A L MEASUREMENT ..
<br />da'Jbo 1 U U .:.PERMIT. :~~:. ~..k ;. si+:¢s:. :~ .::~P }: ry~~~.A::;
<br />-_ ..
<br />
<br />•c:' ., _
<br />' ..
<br />E
<br />~.. ,,...~. _, .
<br />c.rL..r..f .,ItJ.,S YALU. 'REOUIREMENT
<br />.: .. .. ....
<br />,:bat C'kX
<br />8U=0 .:
<br />... .~.
<br />~~.., <:~,?,~„: ':
<br />..:.:. ..~~~ ...
<br />
<br />v .r.,
<br />,~
<br /> SAMPLE
<br /> MEASUREMENT
<br />~ ~~
<br />~
<br /> ~~ ~ PERMIT : ~ :.. ~.
<br />~ :. ~ _
<br /><•:
<br />:fir .. . ~
<br />;~~, ~
<br /> REQUIREMENT .. ^
<br />.. . .
<br /> , . :'Y. :w.
<br />,..
<br /> SAMPLE
<br />•
<br /> MEASUREMENT ''
<br />r.
<br />
<br />'
<br />'
<br /> ...
<br />. .. ... ..
<br />..
<br /> .
<br />PERMIT
<br />.REOUIREMENT
<br />~~~.: .:.:~' ~
<br />~~:~ ..
<br />~~ :~
<br />
<br />;':1.' .
<br />~~~.
<br />'
<br />-
<br /> .
<br />j
<br /> SAMPLE • "~ y+ ~,
<br /> MEASUREMENT ~~ .
<br />`
<br /> PERMIT :. ..
<br />~
<br />~ .:. ... ~ .... ,
<br />~
<br />~ .`:.:~,~.. ,~
<br /> REDUIREMENT :
<br />~~: ,. ~ ~..., ~ . ~ .
<br />.. ..:. ~ :.
<br />:::: ~ .:: ~:~,,.a,,. :. ..
<br /> SAMPLE •f ~ '
<br /> MEASUREMENT
<br /> ~~~ ~.PERMIT~ ' ~ . ~ ~ ~~
<br />~
<br />:
<br />;
<br />:
<br />~~.:. ~~
<br />..
<br />
<br />'
<br />~~~°
<br />~
<br /> REOUIHEA,IENT ~ ~ .~ .~~
<br />,.
<br />.
<br />. ~
<br />~
<br />;
<br />`
<br />~
<br />~::~
<br />:. . ..
<br /> SAMPLE '
<br /> MEASUREMENT
<br />' _
<br /> .. PERMIT: ~. .. .. ..
<br />..:.~
<br />~
<br />~
<br />':.
<br />: ~
<br />~ ,~
<br />. ~:. .: ~
<br />`,
<br />c~f;::<
<br />` ::::...
<br />:~~. :.. ...
<br />.~: ~:':~~: ~: ~:
<br /> REQUIREMENT ..
<br />.
<br />. .
<br />,
<br />.: ,~.
<br />.:
<br />.
<br />.
<br />>:
<br />
<br /> SAMPLE
<br /> MEASUREMENT ~ ra ~
<br /> ,
<br />~
<br /> .: ~: PERMIT... .. ...... : .:...:..... .... ... .:
<br /> REQUIREMENT ~ ~ ~.c -::.r~:..:
<br />:..:... .. ~ .
<br />NAME/TFTLE PRINCIPAL EXECUTNE OFFICER '°^"r° "p`"'Ir°I..Ih.l u l. eer.,mem .m ell .Il•[hlle"°~'^ T
<br />P
<br />
<br />pnep•rtd antler mr dlnrtll•n a ~pe
<br />r.ltlon In aeo•deme .Ilb •
<br />tlem detl
<br />nrd ELE
<br />HONE DATE
<br /> g
<br />p
<br />Io Awre IM1•I qu•nnN pemnnd pnryerll Plha •M n•luele IM Inrennell•n
<br /> w6MnN. e W en m/ I~pulrr M Ne WeeA er penwu.ha m•n•p IM rrnem.
<br /> •r Ihov /ers.e tllrtrtlr mpe~dbk rer plhetly W Inrorm•Ilen. the Inlorvrllen '
<br /> wlbmllled Ir, le the bM •f mr Yno•4dpe •M belle!, Irve, ertvnle. •M mmplelr.
<br />Lm...n lbm lhen•retl
<br />dnom
<br />en.ln
<br />ro
<br />b
<br />tlm
<br />n
<br />l ~
<br />eION
<br />T ('1Z /~' +
<br />L/ ~'
<br /> p
<br />p
<br />n
<br />. m
<br />n
<br />np
<br />M
<br />•rorvwnon, A
<br />URE Of /III/lpPA4 E7tECUTNE
<br />TYPED OR PRINTED IMudlnp lM 61111 ernne •I«tlm nenmrnl r"rtro.1•p.lel•ueln
<br />pm+ r P OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />......~...........~....... ~............ ~. ..... ....-......~... I/•ov o•L• a. maunnm.a n.r.r ..
<br />:'i :i L iR0l; Lief^5 w1 LL tlr_ wAIY`U t; ~~.TTL''A~'Li `i^Llil.. LiN•I1 At dLI dU POH <=~.Qp(i}+~4Ha ~PkECIP BYEyTi T">
<br />i t10:i LI!1iT5 I+AlY 3D i'Ui,. >1~Yne ~4;(Y r.i :•:CIi' AYE',: ~UEIJ F.CT TJ UUkDE\ U'' FkU6F I@~~',.t` X1.2• UIL E Gh EARL. - SEE
<br />- - ar..~z
<br />«~ ~~••• ~~-~ trcev vrr} rrnvlous wmons may be used. This is a 4-pan-(orm. PAGE OF
<br />QU129/Ql~~i•+-a~oo t
<br />--. `_, ~ ,.. ._ ._ .. .._ - -"- -- .::.:.x:_.:~~IYe.n.~.Talc~ll~d~3l~': ~:•' :c~wa,rd,.:ee- - '-a.; r ..-.~n.i.:. w,..._=n_...... _: ~.
<br />
|