|
RERMn'TEE NAME/ADDRE53 prAi/.ernyNrl.r.naw oDleF.wri
<br />NAME ;iELc.CA ;:^.~,iL .U :r ,:",Y
<br />ADDRESS U R A i f: !; J
<br />:'.6Yi'cC CC iS163'd
<br />FAa~m
<br />EocA7toN r ~. Y . ..:1 ,: ~ !: l r' J
<br />_ 1 I - t L r 1. _ 1
<br />xArlouDISCHARGEOMONITORINO AREPORT (O /R/PDESI
<br />,-,~ .fir": ,~„I rlr (:i9_:. ~a)
<br />PERMIT NUMBER: 'DISCRAl10ERUMBEA '~ _ cI;IAL it~Jt)~:.'l
<br />MONL,. 1 `I PERIOD TSCHA RGE 'fU TeI F'/S R:;c '~in'r:ti
<br />YEAR MO DAY YEAR MO DAY _
<br />FROM 07 O1 O 0v ;,: NO DI:iC-HAH.;c +~~'•~
<br />NOTE: R~~d Imtructla.r bolo f eomph/kq Ihh lam.
<br />PARAMETER ~ - ~ ~ ~ ~ QUANTITY OR LOAD , ,
<br />Quality or Concentration NO, RIEOUENCY
<br />of SAMPLE '
<br /> EX KYp3 TYPE
<br /> AVERAGE MAXIMUM U. 5 MINIMUM AVERAGE MAXIMUM UNITS µ
<br />~: ~ SAMPLE p:f ..., :~ } ?'.: r,: t :::} ppl l{ ( 1
<br /> MEASUREMENT
<br />11 ~.1 a U J '1 1 ::i'~ ' PERMIT;:~:':~~' ~ :'.'-~~..::~;.~....
<br />I:...~,.,sy
<br />:
<br />' ... .....~
<br />~<x:aa~~;:~
<br />:xe:,:
<br />.s: ': ..
<br />:: e:;;.:;~
<br />° :.
<br />`:' ;!:;..::'::'' ::;
<br />r
<br />:llcYl . .
<br />Ci,sr^~-
<br />
<br />Yr":. r. •: •, ';s~ v~ I! : REQUIREMENT.:
<br />...:.. :....... .
<br />..
<br />.... :
<br />.:
<br />,.-... .;.
<br />~ a
<br />4~nt~'.:i..,i.
<br />wa~r.rMS.i,ti:
<br />tr
<br />.,t~t.~rl.
<br />::',LI1::;, :.)fAL SAMPLE ::.':'.:." :~::::-^ ~ c~_:_~=u': ( ]q)
<br />4' ; ;; . I MEASUREMENT
<br />r ~ ~ •
<br />
<br />.:, i `7 1 J G ' ~ ' PERMIT' ~: ~
<br />
<br />.:.:..... .. . '
<br />
<br />.-; -.,.s
<br />M..~
<br />.
<br />
<br />.,..,,._
<br />
<br />...#~IR#.AI~,~;:. ,
<br />~
<br />
<br />::J.'. ~ ...
<br />~
<br />
<br />I::, ~ ~. ~
<br />
<br />~
<br />
<br />1't~C ::/
<br />
<br />'; rfF i-~
<br />
<br />..FFL,:F~If ~;RU55 V$ Cf REQUIREMENT
<br />:..:.~ .. .... .
<br />.. ~
<br />... .. ~' ~ ~
<br />.:
<br />:: •:~:-: ~
<br />~', '~'
<br />.'.'::~:~~..d:¢;is:..~
<br />r: ,lill:?A
<br />'A.~it
<br />:: :yt~I~s1v:"j4'I<~
<br />/
<br />~~irFiN:~ r '
<br />_,LIli,, .':,I'TLcl•NLc SAMPLE .... .. -. rfB~iR;r ( ~5)
<br /> MEASUREMENT
<br />,,,. J't S 1 C U :~:::: PERMIT.: :: ~::g .;; f, ri:.,<:;.
<br />
<br />.
<br />.: ~ L,'; .: .. :;; r:'
<br />'
<br />
<br />
<br />:::
<br />.; qrt 2..Ar.'~::.:
<br />
<br />
<br />
<br />:
<br />iF`I::':: ~:: '.:Y,'.e: d'::'3'f?"`1 ~:~:'
<br />^„' ~~:~~~% ~ i:~A :,
<br />
<br />i
<br />
<br />...
<br />. ,
<br />..rrL„r.;T :;t0:,., .:.Ll,. :REQUIREMENT:
<br />... .....:.' '..... :: ~ ': ~"
<br />
<br />~
<br />
<br />... ~.
<br />;
<br />.. .. ' .
<br />i{~. ~.k:y'~:
<br />~:
<br />-i„i ~:"
<br />Ll
<br />;
<br />
<br />^~~
<br />'N. ii
<br />- ~ •~ , ~-
<br />1~ ~~~~
<br />A SAMPLE .. .. ..
<br />~ ~ ~ ~ ~ ~ 1~)
<br />(,.+
<br />YE) MEASUREMENT
<br />:J~t •, 1 U U ~'~:PERMIT ,.:
<br />
<br />•
<br />.r,.>.
<br />.. ,• ,..
<br />...
<br />~ ..
<br />
<br />... ,.; ,, t•'J ~
<br />
<br />
<br />~
<br />~ ~•/1
<br />
<br />
<br />~~ .:. aES 4~ ~~$~~~ iRA C~
<br />•~. .i ~~ ~, r ~
<br />':H YL I: r REQUIREMENT
<br />:;: :. ~:... ... ..' . ~ . .. _.
<br />:.' ~
<br />~.. ~~ :' '
<br />~
<br />~.a:iT^r
<br />.:. 'S ... ..
<br />.~:'iti:3: :.': Y::-:Is ~Y: V
<br />;/ . ':mr i1
<br />
<br />
<br />, ,
<br />;:~` Yli:~ ~;{ . .
<br />.. 4 •, '
<br />.: iGASE SAMPLE .. .... ,.,. ( 1'3)
<br />. MEASUREMENT
<br />
<br />_.:{ ~ 1 J U "~~'~~~PERMIT'':
<br />, .,
<br />.z'x.:_
<br />~
<br />-
<br />.:.x=:
<br />..
<br />~r:
<br />i
<br />rZ31F.T'S A
<br />~n4A t
<br /> ~REhUIREMEN'f ::':: :: ~
<br />.. ..... ~ .
<br />~/L
<br /> SAMPLE
<br />..., 7 1~ C *T .`, E h T P I. A h~ MEASUREMENT
<br />.:!'i': 1 U 1 )' :.:PERMIT::. :iw.l'C3:'i.i'''.i fi':.'A.~i r'.t::i :;- .. - s, : ;;:k't::~.:f~:= ,- . i~{Cfll' ZAiSFA'
<br />
<br />~. .
<br />,
<br />t , a, i J F. U S V pREgUIREMENT. `3.G.~ ... A.. C~ 7 A T' . N ":
<br />
<br />
<br />~
<br />
<br />..
<br />
<br />.. v't'Y
<br />
<br />d
<br />
<br />
<br />
<br />' %#S21!::T r:
<br />:.1 L , ~ . T A L SAMPLE ~ .. . ( 1 1I
<br /> MEASUREMENT
<br />.
<br /> .....: pERMIT~i~:~::::~ ..:.•..,, w ~:.:; w.iS rr<h C:z. ' ... m ~ ~~ .: l,'6 ~S:L.Y G 'ul .+
<br />''s" J- ''H' 'S Y A ..I REQUIREMENT' :.::.' '.' .~:: ::'.
<br />` F:;:?~T: ~ AV:':' mi '1 K.I~I: ~.,:~~$4~7c i;:./:.
<br />NAME/TfTLE PRINCIPAL EXECUTIVE OFFICER I aeon) u o pnu V a ,w Ntl 0 h Eolarmnl •M ,N •II.(llrllnb w1rt ~ TELEPHONE DATE
<br /> ortP~~u~~~mr a~~~~m~p ~~m....a.n..,nm..rnem a.t~n.a
<br /> m
<br />m
<br />nn
<br /> .wrt
<br />.yu.
<br />aa pnownd v,up.nr ~.m...na ..wa m.inmrn,abn i
<br /> alminN. nea on mr Irpulrr nr Ne Anon er p,ve woe nunge nM,1,l,rn.
<br />'
<br /> or lnW pram tllrtcOr mprdNe ra pNMnE N, Inr•rm,lbrt lne lnremrlbn -1~ (.~~
<br /> wnminen4 to lnr blormr.m.Mi~e,M p,IIM,ine. we.rnle,uM mmpMe.
<br />I .n,...rt ua mart .rt tl
<br />mnum
<br />n.me ror.un
<br />rm
<br />nb, I
<br />f
<br />lb - /
<br />610NATURE OF -IIINCMAL EXECl7TIVE /)~ Z
<br /> p
<br />.
<br />n
<br />n~
<br />n
<br />•rrm
<br />w.
<br />TYPED OR PRINTED In.+wlnt m.p.emnymm..na lmF,ILnmrnl rorano.in~.la.uom. OFFICER OR AVfHCS RED AOEM CODE NUMBER YEAR MO DAY
<br />COMMENTS ANO ['xF'LANAIIVN Vr Apr rIVLA INNS /RIl//I/ICI I//IRIC/ITp1fJ /,I/I/
<br />' (-).'~ LIYII'.i iIL: .` '4I'rt7 %. .. '. ..i"-il'A~L.' .i .r p.:'L~' ~,~~ ~=:~.)f'.r_," ~';l'.'IF EV'."•f,°'
<br />.~.i\' LL5I~5 eA.Vr_.J tU:, >I~iYtc,l~ii:: P"ii~I: :.1;.'IT 5!y~J~~ T.. :,~;tL+r:tl ,}' ~ ?r 1. ..-.. uT_L v G=, ::A-°°.-....~
<br />EPA•Fa9n13320-1 (Rpv~3/99j Prebi'ous ~aifiiilis Foray b`e•used~ • ~ This Js 4- a orm. PAQE of
<br />I)c:J~/UUU/la7-g~lfc, 1
<br />
|