~~
<br />~~
<br />Itt~
<br />~~
<br />~~
<br />ICI
<br />PERMITTEE NAME/ADDRESS R.wbM F«vLy Nmr•~Lomrlm iJng..~p
<br />NAME i .. ~ ~ ~.. I - i ~. i 4 ,. }
<br />ADDRESS ,I ,i , .. ',, ,~i, .d .~
<br />FACILITY
<br />LOCATION
<br />PARAMETER l3 Grd Onty! QUANTITY OR LOADING lI Grd Onlyl QUANTITY OR CONCENTRATION NO. NtEGUENCr SAMPLE
<br /> !de-531 150.81 - (3BJ5 146-53 16481
<br />l31-371 EX MNV9s TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS a1-Ea/ 164681 /89-701
<br /> SAMPLE ..: %k# 'k'k :=kfi=: .- ( ~_7~ ! r
<br /> MEASUREMENT 8j ~ ~~ ~ Q A irL-~r~Ll-
<br />J~J i ~ ~ ` PERMIT xkk-. '. ~ ""-#;`~Y-.j:# ~ #'~'.>: ~~.~ ;k;», Le:,F ; e
<br />-, c ' I, ~ ~. t ;
<br />
<br />? REOUIREMENT - '"'~ r ~q I>N.~h il i~i_ '
<br />tI~XIN}UM ~
<br />Sii
<br />
<br />:j
<br />
<br />~ .
<br />:L} )-'.r ..'.'i
<br />!.':-'~i," SAMPLE .r.-r..- .-..r-r. ~ r".i:$:<:~ vv~,.w+; ( Zri) I ~
<br /> MEASUREMENT 0 O `
<br />•4p
<br />;t; '1: I - PERMIT r~k ;K k::•. r#~tX:;:~r. PAZ' /.
<br />Yl!YY1•l,~ Y'f: 4---F ;ti 05 )1CF./ R~AR
<br />', r' [ `, J `, Y ; • ;. I ;
<br />- REQUIREMENT
<br />
<br />~ -~ -art k ~ - '
<br />"[!KIEV !'SX
<br />'7L/L
<br />lK~R H
<br />:
<br />~ L L. k N v SAMPLE
<br />MEASUREMENT .. -k .=; r,-':.°-; ti ~ -
<br />rL/~_
<br />( A~)
<br />~
<br />~~~
<br />
<br />J3'r : ! i ) .I PERMIT -., i`-vx~'k "•k `-~F t~'.~'f
<br />^ =;;k:;: : tc._k :="v..° i.<.•F .`-:."• ;k 1.7 N~TIY RAR
<br />"[..+ ~ , I~ . r,+. :. , -, :REOUIREMENT
<br />
<br />.. ~.. :k #r;»
<br />i)dLLX ~tX
<br />"iG/L
<br />.ytNT
<br />r'L.?Ar iln ..,i~i~:;f ~~ 1?
<br />'
<br />~ SAMPLE
<br />Q
<br />~ ( ~3) ....-.~. .-. ,. .. ~,.-,:"" i
<br />~ v
<br />'f
<br />li%~d ~
<br />r+' i. " ~ ~ -' f. '. 'i 1'
<br />L MEASUREMENT i~
<br />~ ~ 1.pJ
<br />at.
<br />IJ ).)J ?_ ~ i PERMIT i~il7'3.(lL< RLl'I?i`')RT~ `-vi'i is i-P,•0 i=-'~~`,:=;~; Hwr :=$# ..
<br />.
<br />NCE/ S
<br />,N_TA
<br />-. E. 1 -1„ .. ,'.,) ~ : d i.'. 'i 'REQUIREMENT )!,nA
<br />.) V I/+'4 A YG ~ DA. I L Y: ~. L1 X ~, N GD
<br />."SOHTH
<br />Jl c. .i ei - ': '+ ~,. SAMPLE r#k5k# yq
<br />v I ., J i 1. MEASUREMENT Q 1 ViSua
<br />I l:l~:t 1. } 1 PERMIT ##R k1Fr ? .'.IEPJRP. ES=L ~r#.:M;? t:###" # :XiyX,'%k#]Z - ;t#+ NSF./ ISUA
<br />r' - }..!': L ~ d + ', : ::REQUIREMENT ~ ~ I7tST :'rtA X "' NO=D ~ "## ~.
<br />n~Nrit
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT. -
<br />D REQUIREMENT -
<br />n
<br />n SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />~
<br />~
<br />~
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIM VNTH THE INfO11 UW THAT I NAVE PERSO
<br />MA710N SUBMITTED H NALLY EXAMINED AND
<br />EREIN; MD BASFD ON ~ TELEPHONE DATE
<br />- n
<br />~ZlC~~ • /~w~.50+~ MV INOVIRY OF TH09E INDIVIDUALS IMMEOIATELV RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION, t BEDEVF THE SUBMITTED INFORMATON 19
<br />~la_
<br />_
<br />
<br />
<br />/
<br />~
<br />C
<br />TRUE. ACCVMTE AND COMPLETE. I AM AWARE THAT THEIEE ARE
<br />SIGNIFICANT PENKT(E9 FOR SU9MITTINO FALSF INFORMATION
<br />INCLUDING
<br />I`
<br />9
<br />~/
<br />
<br />~~ /
<br />
<br />~
<br />l~~J
<br />~V~
<br />~~
<br />V I ,
<br />THE POSSIBIUTY Of NNE AND IMNUSONMENT
<br />SEE 19 U
<br />S
<br />C
<br />] 1001 AND 3] - E
<br />639
<br /> .
<br />.
<br />.
<br />.
<br />nl
<br />us
<br />c
<br />E t]tD
<br />lA
<br />M
<br />d
<br />I4
<br />4
<br />M
<br />IO
<br />D SIGNATURE OF PRINdPAL EXEd1TR/E .
<br />
<br />TYPED OR PRINTED .
<br />.
<br />.
<br />wb
<br />rA u
<br />sA Ip ro t
<br />r
<br />wr mans m.Y
<br />rt
<br />rdo
<br />,OO
<br />~~dwmuMvn ,HrPdwlwN OFbrwwn anNntluWawn.l
<br />OFFICER OR AUTHORIZEb AGEM AREA
<br />CODE
<br />NUMFIER
<br />YEAR
<br />MO
<br />D
<br />~.~mmcn~a n~~~ r~nnn w.. ..r ..~.~ ....~..~...~..,v... o. o~..o o.. o..a~.~...onm .rein
<br />i:,,:.'' :...~. . _/t,l: t.L }. 2 -t :fir^; i1 k'tYd L~-YR~ l9-HR 2R?.':CL'2 '4;{N L' Ju_.~t...'1' T`I "ilRp';ti ;Ir X8';7' ^.,."++.lTR';21E8P> Iti
<br />,'t iC i...l..~Jr p. ,. ;C:fli~tBAS*;E RxNIl;E481Yn ?LAN DUn L-L-7:i.
<br />Fam 3320-t
<br />may
<br />NAIIOHAL POLIU I AN 1 DI5611AI W L LUMINA I W u
<br />DISCHARGE MONITORING REPORT DMRI
<br />2-18 17.18
<br />caGasao32 oUi a
<br />PERMIT NUMBER DISCNMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YE R MO DAY
<br />FROM TO
<br />!20211 !12.131 !24151 !18271 128-291 136311
<br />NOT BE USED.I
<br />f)?~ q/ )7;Ja1`?-1754
<br />~'i k; C L L'.1 . ,.. vIA~~Nu.11040 p0 .
<br />(SUER $E) Approval eYE31{P~QS
<br />F -~ FINAL ~ 1L `y,
<br />t7INOR ~ ~ 7i~' a
<br />... NG DISCIiAftG'' I__I #'-"`
<br />~. NOTE: Raad Inatmctiom baton compMtinp ttda twm.
<br />L
<br />
|