PERMRTEE NAME/ADDRESSR~+F.NryN~./E.r~r.l ynbrw.p
<br />NAME '.SLDR4D~: f^°I'A C^RL ~". A'~'i
<br />ADDRESS~T'1 E`i Irl•i .1 S(17 m'~r , h':. ,."n:•) ?'~(
<br />FAIaLm
<br />t.OCILTXNI_, r, r: .; .. °: =. y : ~ ~+ 0 4 t. 7
<br />°f•i: r~.r~=laol. .~.lol.n>. '~~ '!I•;~ h:F'.
<br />NATIOMK pOLLIRANT d5CNM0E ELIMINATION srSTEM NPOESI
<br />DISCHARGE MONITORING REPORT (D R)
<br />" `~1' "J rig 1 h
<br />PERMIT NUMBER dscNEAaE NDMeER
<br />MONITORING PERIOD
<br />Y6A MO DAY YEAR MO DAY
<br />FROM ~ Qy ~I TO OZ Olt i'?
<br />Oro
<br />",i
<br />(S; i ~~~
<br />T': R1,
<br />[, ?OND
<br />
<br />
<br />NOTE: Rrrrrd MutrtlFtlorr brrlorrr eomplAtMp thH lorm.
<br />
<br />PARAMETER QUANTITY OR L ~
<br />~
<br />Quality Or Concentration Np, FapouENCr SAMPLE
<br />
<br />X pp
<br /> E ANNrss TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE ~ MAXIMUM UNITS
<br />. ~.., ; ' ° I 7 T T Y SAMPLE
<br />U
<br />ME ;: .; a •<;e r r.:~,• ~i : '~ p04'~': ':
<br />~
<br />l
<br />~ 7
<br />`
<br />~+ r 1 1 }
<br />'
<br />4~~xC
<br />~i'A?',
<br /> MEAS
<br />RE
<br />NT j
<br />i
<br />~ ~~
<br />~ ;
<br /> ,,:...:...<. .. Q' , ». -.>#. +asr ~ ..y .. ~r){:¢IfR:fk>X:. ` ,.>.
<br />,: A''~P~{iT: ...ga`'.F'+C%r?"2":::
<br />... ~ ;r <ir~- / ,
<br />°FLJr,NT :;d ):iS YAL 1; .,
<br />~REQUIREMEN2:..
<br />'::~........: ~: ~.:.~ ... ..: .:-
<br />:::.:..~ ~ ...~:
<br />.....: .. ~~.. ...: .. ~
<br />::; .: ~:::. ~~:. ~: ~ hlyr,: r:>:' s..: ~;.: ..:~~ .
<br />.A :::R',3~;i~ ..7~k};~~'..u~..t^':~:[: .- ~..:.1;; ,•,,
<br />1 SAMPLE
<br />MEASUREMENT ,p r. ;; .. ..~ .r r;;••bX••
<br />7r~
<br />i{ f
<br />~
<br />;j' r .
<br />`) /
<br />,~,/J. I~~°~~~
<br />').I .I ~ 1 7 7 ~~.~~. PERMIT .~... ~'"%,x t} v
<br />~ ....; .., ., 1..:. .. .
<br />~~ ~~~ ~;:.+,'Lydita ri
<br />~~ 9::.~
<br />~~ c '~~I
<br />
<br />
<br />-rrLUFt!T LH~S~ YA.Lt.'F. REQUIREMENT
<br />
<br />':.~:..:: ...~ :....:. .: ~
<br />
<br />:......: :.. ~" ~
<br />
<br />:.,
<br />
<br />..
<br />
<br />".N !l Utff:~.- :
<br />;.:...'
<br />i:.'. .. :.. .~..:
<br />
<br />.:74A Y~~[~??iF:!!T:~~
<br />)L1D~r TJP11. SAMPLE .?XCte~: y.ypr*^ .. }+krsQL ( t I)
<br />. _~ r ~ ~ ~ D MEASUREMENT NA r%A 1~ /,),q ! ~~
<br />
<br />` ' ~ 3 u D D D .::, ,
<br />'~~.:~-•.PERMIT.~;)~ts
<br />:-a~C:Y91~~:~:::.:
<br />.:::.~ .YO~s~.~:at ~ a
<br />a ~
<br />~ #.~rrpgr
<br />~ ~~ ,. :.:. ,;
<br />
<br />~~,.: ..R
<br />P
<br />
<br />;fl.R
<br />m
<br />E
<br />~"
<br />k~?~;~ ~ /~
<br />a .t
<br />_;,,; ... ..
<br />._ ..~n-',eKrs Bc.LON :REQUIREMEN.T:
<br />:.:..:..:::..::... ~~"~.:.~~~: ~..:::;:~~:~'..:.:
<br />..:..........: ..: ~:..:. .:::;~~~.; ~: ~..:.. ~.~
<br />: ....... . .:... ...~.
<br />k.,... :
<br />'a ::~L7 €
<br />ls? .
<br />sY"::?t11:
<br />z
<br />~ Vii:/:. ±s.r3ka:~
<br />:~-)Lliljr TOTAL SAMPLE '.<r. .:^.•^; Or: r.anC~ _: ::a;c _
<br />
<br />L ( i'} I
<br />1
<br />~~
<br />(
<br />1~0.(0
<br />'.15PF.Nl>ED MEASUREMENT J
<br />~I 'q IC~ I
<br />~, ~' ~
<br />.; .11 i:i i J i ~.: ~.-.PERMIT.:: :. .. •x ;: °;, rrv :_ ....:.., :.:_ '` '- ~ .., .. A;F:. :I~~c :>: f.. '~7 ti
<br />'' ? L J ; +' T .; ~ ] : ~ Y 4 ,~ ~ .REgUIREMENT ... .. ~
<br />,_ .,
<br />... .:
<br />
<br />3Q#Y. ; :'-t:Y : .. ...
<br />
<br />::`~3I'i;:~!':: :~'<
<br />
<br />hin/ L
<br />
<br />I~.OlIe.TH
<br />
<br />.
<br />>,7L[~3r SbTTLP.AjL,. SAMPLE ~.-r:}::, ..n}.. :. .. .;-^'~~" ~ 25}
<br /> MEASUREMENT .GDI ~ I ~ ~ • (J,1PV.
<br />
<br />. >~.1 u O U ....:
<br />.:;:;:.,..PERMIT..:.:.. ..
<br />:~;..~C.fjL~slA.$.L: ~...
<br />:~~s: rp~s @s..#>k
<br />~.. .-.r'<a~.~4.~
<br />~>
<br />..: ~
<br />
<br />~
<br />
<br />/.
<br />=
<br />M
<br />P.A..
<br />L
<br />
<br />_ ..
<br />. _ ,..., ~. Y f i B g L J d
<br />:REQUIREMENT
<br />::.::::.:... ...:~ .
<br />::~ ~. ..~:~~~:::~...:.,.
<br />.. .:.::. :.... :..
<br />...:^.:..:.. .:: ~~~
<br />~:.:.~.: ~
<br />
<br />~a !-
<br />~
<br />~~ ~ ~
<br />
<br />~ ~~
<br />~
<br />
<br />~'.~~~~I~:'az~.'~et:q.:.
<br />
<br />.. L / 1.
<br />r- ..
<br />;`s
<br />,.:,.::~;
<br />V
<br />. ~, :.
<br />;~;~...,
<br />~f~3~'~$:H
<br />.
<br />.
<br />- LI"5r Ss TT Lf?AHL" SAMPLE :: rr .^, :. ;: .x r.:-+r-•- .. +~cC.^,t~` ( ~,
<br /> MEASUREMENT ^~ ~k ~~ ~~
<br /> ....: ~.~PERMIT: :. :: .::...6 G~t~X=: ,~. "::s>ga#•:a~&. ...
<br />
<br />....
<br />• ~- ~'.;r~:~#.x ~, ~:~;. a~o:~ ~O~R
<br />R;': ~.. ~tdC'':!~ 'D~". '+
<br />L
<br />cFr'LU~`IT ~3't;i YALI1. REnuIREMENT..
<br />-:::...:. : ' .. .
<br />~.~.:
<br />
<br />.. . .
<br />
<br />
<br />n~TL.L..:M4t:
<br />
<br />
<br />L/L
<br />
<br />
<br />liRN?x
<br />
<br />.
<br />,..
<br />:`: i'R 1. 4~~:~VEhA:`Lr SAMPLE
<br />MEASUREMENT '.-~1s x'=': .. , . ~ _
<br />~,~J _
<br />u,~o ( 1 ~~
<br />~
<br />~/~
<br />~~'0,
<br />
<br />.
<br />.."J i J 0 "r:;~::FERMIt~::;:~::~
<br />:.. ' .:#xt~#'#::4:~~ ~cr•~r`«C~a. y.tt,:la;E:^~'
<br />
<br />.,
<br />'P'~?2T.~: ~:~~H1'.~~r~OftT~ . :3i~Z.CF/ ;?tA•:
<br />'LUSFIP GK7` YAI ; .hEQUIREM@NT~ ::..`.`~:. ~~~~~:...`: :~.~..:::~.;~~ ~:,x•: ~ ~ ~ ..3:?'+ ..A~Y:,~ ~~:.fl$I:I,Y..r% ,'";/L 'r }N~ON~TP .
<br />NAMERITLE PRINCIPAL EXECIlTiVE OFFICER I rtnn, un er prm IT or ln. Ibn Ih h eotemrnl nM .II nunrb,mnl•.rrt
<br />TELEPHONE
<br />DATE
<br /> prtpnrtd anew m, dlrtcnon nr mpr n~on In rtorennrt dm uptrmawlEmd -
<br />/ `
<br />
<br />Ml
<br />M ]
<br />~
<br />?
<br /> mmnrt i
<br />gm
<br />nee pr.wnntl ProPrIr PIMrnM mNnle rbe lnlermnrlnn
<br />b
<br />l
<br />E ~
<br />~
<br />~ r
<br />
<br />'J Cflr. rd i 1115 .o
<br />m
<br />uN.
<br />nwd on m, Inqulp sf Nr pron w prawn .Aa mange rM.ptrm. ~ ~ '
<br />i~ ~ ~ ~ / r~ u ~ ~.t _ L ~ ~ p
<br />V
<br />
<br />or rM1wr wrmA tlll.cN, IVpnMbk rw inlbeAnt Nelnrormnllm,IM1e lnrnmullan _
<br />/ / .~ V L
<br />r~vir'onnlental Managr_r >wb~Il.el.InlM1.bwlnrm,.n..~a,r..tlb.Nrr.l.n...~rtw..l~rtmw.l..
<br />I ram n.nrt 0nnpen .rt a
<br />anuM
<br />rnxn
<br />rm
<br />b
<br />NU
<br />r
<br />Lam
<br />n
<br />610NATURE OF -RINCMAL EXECUTIVE O;I j ,K
<br /> p
<br />p
<br />w
<br />m
<br />m
<br />nr
<br />n
<br />nrmn
<br />on.
<br />l
<br />TYPED OR pRINTFD Iw
<br />ualnrnw qr Yellll, ornw.na lmpMonmewr rnr Lnnwlnt .IW.uors OFFICER OR AUTEIORIZED AOEMT CODE NUMBER YEAR MO OAY
<br />COMMENTS ANU EAYLANAIrvn tlr rant rrvl,Alwns lnn~rinn ~n ~rncnmmrt n~r~/
<br />~~" Yn°r. ;?':; f2" T`; ` '£T'L::A.PL.. <,:)L1G (L .. ' ') LY I:s~ = i^-Yur?q_po PReC7P EYE':°• "•.. [`~
<br />OFF PAu^, I.1.7., i'~. ri FDR dUP.OF.N ~F Ptt'1~F R=^O i3"~~'"'~~ . '`?!. f, ,.'-.1'-`' - :;EE 1.^.1.'?ir PS. 11.
<br />EPA Form 3320.1 (Ite'v 3199) PTl:vious editions may be uscl~, Q 0095 / D LE~sli~ ~ a,P i~l'OErt1. P't'OE i F
<br />
|