|
IERMTTTEE NAME/ADDRESS pwii £uYryNrwW(,eruva f/Dbirrwq NAt10MK f•DLLViANI dSCHMOE ELIMINATION SYNT W //NPOESf
<br />NAME .. ,~ i i _~ DISCHARGE MONITORING REPORT (OA1R1
<br />. ~7,. J.
<br />ADDRESS . ., R . .. ., ~ ~ i ~ i (~ : H y
<br />d , ; ~ PERMIT NUMBER D14CNMOEMWNEII :~ _ ~ , _ +:
<br />f, _
<br />FACILITY ~ ` t o :''. " U ^ i . '''_ 5. ~ .. .
<br />MONITORING PERIOD
<br />LOCATION YEAR MO OAY YEAR MO DAY
<br />FROM -' 1 .+ ~ ' 1 TD ~ 1 ~ ~ '' 1 ~ C F: R a ; :.
<br />' ~ /:, - . ~ NOTE: R~~d MnWetlarr b~ftxi a {pMllrtp IhM Iwm.
<br />PARAMETER OUANTRY OR LOADING Quality Or Concept ra ti on NO. ~ FIIEOO; NCr SAMPLE
<br />
<br /> E% ArIALrsIN TYPE
<br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS
<br /> SAMPLE .,. ..: ..~ ..; ,~.: :... { :
<br />')
<br /> MEASUREMENT . .
<br />
<br />.. - ....
<br />~ '.J r IlEQL11REMENT:; ~-> :::.......:.. ~~:
<br />, .,.:.:~ ..:: ~.
<br />
<br />;. :. ,. ,
<br />:.:.
<br />
<br />
<br />"
<br />
<br />
<br />
<br />.
<br />,....
<br />
<br />
<br />
<br />.: ..
<br />...tit:.: : ~,t~ ..:
<br />
<br />
<br />
<br />
<br />
<br />• .
<br />•
<br />
<br />
<br />
<br />.
<br />..'f --., ""iI1[. SAMPLE !r -. 9'A:~ .k :<Ft.## :}Gk:+hh (
<br />lq~
<br />_, .I ~_; MEASVREMENT
<br />~~.r 1 ~ ~) ?:''::PERMIT.,::': :~~'i ;:^r~;';< . .:..:-;:~~.aY,t. ~ - ,.. .'. .k<
<br />` ~.j '., ::,'.~.>.•.:; °;: `~
<br />.
<br />~:
<br />.
<br />,
<br />7~~ ~~ ~NCE/ NAd
<br />' _,`tP ;RJS:; Vn..u tiE0U1R~tNENT
<br />~~ _ .. i:~ :~'~.
<br />:;. ..
<br />..
<br />..
<br />.
<br />.
<br />,i,}'.•, ~(':: It;: ~' Y ~4,; ~~~:g .
<br />.... 5, iFT?'L :. -'. i.. SAMPLE .. r. rg ;Y ~
<br />~ :c :.. ( l)
<br /> MEASUREMENT ~ ( •
<br /> / ~
<br />': : "+ 1 -_
<br />J :.:.:: PERMIT.: ~ . ~-: Y:: -:':.:}r" ~
<br />s tit
<br />.. .
<br />~ ~ :: ::':'~ ; ~: ?- ~
<br />;;:•':':. '
<br />,.
<br />l.:: -~
<br />
<br />
<br />
<br />:...
<br />~sS '/
<br />,.
<br />~ .'•;~ .:': ': .t ~~
<br />
<br />
<br />
<br />S
<br />~
<br />~
<br />.
<br />- A ~ ~:.,[?:Q~j'a ::..
<br />
<br />
<br />~
<br />:.
<br />.
<br />{''. ..: .r
<br />
<br />
<br />.
<br />~
<br />t _
<br />f
<br />
<br />
<br />A
<br />... r - ~
<br />:' L'.:. ;Y .,h ~... v ..
<br />1 Q ~REOUIREMENT.
<br />:. .:...:. .. .. .. ,.
<br />.
<br />.:.~
<br />~'::.::':.'.. .~-:' ~(::'.:: ~: ..
<br /><.;. \1~i% :::j`"
<br />. .
<br />~
<br />'°°~•
<br />.. L:e' .
<br />:::.. ,.:.:..~':-:.:
<br />a..
<br />i.: r ~.rty,n
<br />
<br />'.~ _' T a :.
<br />•r
<br />SAMPLE
<br />
<br />..:.
<br />.....
<br />` <: x
<br />r ~ {:
<br />J ...
<br />~ '- '' )
<br />
<br />
<br />~,. .~ ctrl MEASUREMENT
<br />
<br />~;
<br />
<br />~...
<br />+
<br />,
<br />+ . , 'v :.'..: PERMIT":::: :.~:.:~t41#'>~i,LF 3.:,.
<br />
<br />~;
<br />~
<br />'
<br />~
<br />~ ::.:'.:r:,~ °: b.4r;r:..: ~
<br />
<br />: ~.:
<br />~
<br />~~
<br />, 1
<br />xt: l
<br />i)c
<br />.
<br />~...~ . '
<br />
<br />
<br />.
<br /> REOUIREM.ENT ,. r.:,
<br />:
<br />:
<br />:;
<br />~:.:.~.~ .
<br />..
<br />.
<br />: . I
<br />.
<br />..
<br />_. ., °r)~ :.±cA ,. SAMPLE v{sO4n` .^=F~G.4Ar,. ;ra: ts:-~: vC.. x..: { l~)
<br /> MEASUREMENT ~/
<br />- ~ i J .... :..
<br />..
<br />
<br />.,..I_. !.. _..
<br />... ..
<br />..
<br />:.. ...
<br />-~..
<br />.. ..:.:..
<br />:::!:::<._.',;,:,.. :
<br />... :. ~:.~~~:~::::`?:;;
<br />~.:;::'~~$:5-4'`:".•i~:74'~'
<br />Y,G/L
<br />,:....;'::..
<br />•;b`.;F:fir.:
<br />f':
<br />r
<br />~ SAMPLE ( ~~) r,#~ ~~:. •, ~:'=fi :"tt'.+#
<br />,,,
<br />~ ~ MEASUREMENT
<br />~~;
<br />1 'PERMIT ~~: :. ~ :~t'Ol+.l'~~.:
<br />~.~~ :',:"..it"'r"nr; G':,i':: ~' y`e...; rte.::=.<: ~ :*~:*t-a'2:<'-~ '~r2 <;'~~rx''.: ~~ i~~~z.."+hY .~'~5 :"A
<br />,
<br />. .REQUIREMENT .
<br />L S ~ .
<br />, ,
<br />
<br />.. ~.
<br />
<br />~
<br />_
<br />.:. ? o ~
<br />~ ~ SAMPLE ..........
<br />.,
<br />~ .. _ :.:. ~• # 1 1)
<br />{
<br />•";LYF: MEASUREMENT
<br />~:
<br />~
<br />..::.
<br />,.. ~. , J ;:';':': PERMIT( :
<br />"%'+;~':t';. :. ~. ~I,E?Yx: »:y. ~ ttk~%?~, ~t1'PP~I^N'F. h.-';. r :~:''l?:~r 0$
<br />: {':-
<br />'.j'si t.'I {d
<br />.
<br />.. ,. ... .r .. ; n-.REQUIREMENT ::~:
<br />
<br />...
<br />___ _-
<br />_~
<br />~ ~ - -
<br />~
<br />i ~ i .
<br />__ -
<br />..
<br />:b!
<br />'.r..n .:a.
<br />~.:,
<br />_
<br />'noon apen• to •w Nn Nla darvmenl•M tll tllwhmenb .•rt TELEPHONE
<br />NAME/TITLE-PRINCIPAL EXEClJi1VE-0FFICE-~ DATE
<br />Pnyna rnarrm alnrnon orw
<br />~ pnlyan In Rorarna wllh • r)+lem ael[M
<br /> Ir.plln lbi qu•NNea peronnd p.vp Nl [•INR •M enN•le lhr lnfomullon / ~ / - _
<br />
<br />.. Gcrdon Peters rubmllira. N•wd nw ml In9ulry or INe prron « pnanr who m•n•ie the ryrlrm,
<br />ormo.ryr,nma.«nfmpeww•fnrN•mran[Inrlnrom.na,.mrmrorvrn•n L~
<br />'~ `~'"`~ )~
<br />9)U-8'L4-4401
<br />Ul
<br />U4
<br />2
<br />
<br />'Y23 [d
<br />t/Gene a 1't" wbmlllra h. w INe bol or mt bmwMd[• •M beNef. Irvq RtVnlr. •M wmplru.
<br />;
<br />er I•mvrturlmmmY[MNnm pn•we rrrabmlmn[hl~mmmuNm 810NATVRE OF -RNICRAL E%E LYJTIYE
<br />TYPED OR PRMITEO ,
<br />IMWInitM pMbnNT wn•r •na lmpMnmem ru b~.owln[.Iebuoln OFFICER OII AUTHORIZED AGENT CURE NUMBER YEAR MO DAY
<br />t.vmm~~...r nn.r .... ~........_.. _. ..... -._..... _......~.,....,~. .., ......,,........ .....r
<br />. _ ~ b.:. 1 :. .' \ 1, 1 ~ 1 l . • T (. L fl ` A Y. T ' , .. ~ „ i ~ O : . (. _ .. L L ~ . ~. i i 1 A ~ J (_ 14~ J C = 1 '.) q f'. , ~ ~ C ~. ~ .. n !. ~ ~~ : ; I ~ -
<br />.. -+.t'v J i~.I')J P:;(JLHB':;aTS ll"t .. T.A .."L'". ';i:; T9(-. 1:. L. ...''i5:1.''',-,,. M,AS ..:'S ":) =?f:,
<br />EPA Form~332 -T ~• 3/ 4) ~~ VIO 5.1: Mods a}' used. ' -' - - ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ • ~ q. PAGE OF
<br />~nnn~t in~~4a• Dat{tC4rm.
<br />
|