<br />PERMIITEE NAME/ADDRESS p,.64l.Y~ryN~/lse.ne„!/ONG.w,y
<br />NAME `;UL:' Ui y~M['A L":;L _:J!FAilY
<br />ADDRESS:'[K°.'; l,Lf SO'1T~1r ,, ECKM!IV pv
<br />G1S15 RC3 M127
<br />J;IR C9c.°K ,.~ N~4oT
<br />FACILITY
<br />'p~: wT ^v n_; 1. ii~l. il.. :t'H r?T`. ~.
<br />NAnonu rouvr~Nr dscN'AGE niMdAnoN tysrw /INPDESI
<br />DISCHARGE MONITORING REPORT (DAIRI
<br />•T7t
<br />,. ,Et3M1T NUMBER d NMOENUle01
<br />MONITORING PEp~S-
<br />MO DAY YEAR MO DAY
<br />FROM D 3 ]. Ta 1 ^ ? 3
<br />i 17'!
<br />($p3ft .IC)
<br />r. - F: :l. RDUTT
<br />F~t• n.. al r, c 'r:~ FDrD'.. _HP9K
<br />NOTE: R~rd kwtrucNarr bralwrr complratMp lhb Corm.
<br />PARAMETER QUANTITY OR LOADING
<br />Quality or Concentration NO, mEDUENCy SAMPLE
<br />
<br />EX of
<br /> ANAlyme TYPE
<br /> AVERAGE MAXIMUM UN 'MINIMUM AVERAGE MAXIM
<br />U
<br />M UNITS
<br />_)!i 11l .'^'d[^.{
<br />1 SAMPLE
<br />MEASUREMENT ... .... t:••: •<e, .. .., reR4k. /1 ~7 p
<br />~]
<br />T3 ( '''
<br />'
<br />:
<br />~
<br />~
<br />t"F`f~~
<br /> ~
<br />`-('i.J J
<br />! 1 ~ ~
<br />;
<br />,
<br />J741 1 ) J :i ~::~.PERMI7.::.: ~~: ~~~ :: ..«(.~~;j.,. ~~' ...~~'a.'<Q~:gF;'%it h :F.,k``:'~~'
<br />" iy5
<br />~(y'~~'~i..t
<br />'RE
<br />~ •.. .F ., !..~;.;i
<br />
<br />. ,~i~
<br />
<br />
<br />FPLJt'eT ;d.)SS Y4lnr . ~REQUTAEMENT.:
<br />
<br />.........:... ...... .~:::;:~ :. ~
<br />
<br />....:. ~ ~:
<br />c:
<br />.•:::~~.
<br />:~~.~~ ~:,~.:~~~'.~;.
<br />
<br />as .
<br />
<br />.: :.:
<br />~~ ~~
<br />
<br />#~~;..~:
<br />
<br />~
<br />.r:~.,::.~:"~~~.;.:.ni;ip.:
<br />
<br />.,
<br />
<br />.:
<br />
<br />;,~.,
<br /> SAMPLE .. ^o^ .~i. ;.~. #4+~` : ~
<br />( •
<br /> MEASUREMENT ~,S
<br />- 7',,[j . ~" ~j ~ ir~
<br />~~•
<br />~ "1 7) i 7 :1 ..::..:PERMIT ~:. ~ x.~~rp:'~~;ri ;..: ~ ::,~...:- ;
<br />~
<br />~ ~ ~. .: ~
<br />.: •
<br />" .RXrK**:rLt
<br />i~~~.~ ;~?. ~
<br />
<br />9. ::;
<br />~ ~
<br />~
<br />~~ ' '! ~ :..
<br />. -
<br />"'F LaE'.L ,~t"1 '::~: Y11[,i,- .REQUIREMENT
<br />..:.. ~:. ~ ~
<br />... .. ~,. _ ~:
<br />~ r.: ;.. .^~
<br />ti?:~LI1S .~ ~i:'~...~~-:.. ' ~~~
<br />~ ;i'
<br />1L[~:,, ..';'.,L SAMPLE ~ ~ .. ~ ~ ...^a i ~~1
<br />;, c yJ ;,. ^ MEASUREMENT ~ k ~q p )h ,~li t F~N
<br />~ iJ 1 J J .:....PERMIT: ~::~
<br />~ fiS
<br />"':s ~''`?~~~ ,~EQ~~~`~:::? .
<br />:
<br />'~~
<br />„~R R
<br />~~
<br />:' ,: 'n:T .i:
<br />
<br />
<br />L
<br />. av ,-J... '!!('i 9°i.aN :REQUIREMENT:
<br />
<br />
<br />.. ..:..... :.:....: ~~ ~.. ~:
<br />
<br />
<br />. ~
<br />.. ~ ~.
<br />...
<br />
<br />~ . .
<br />~ .. ;::
<br />~ ~~
<br />.::.
<br />~ : ~ .
<br />..y :......:. :
<br />i.
<br />.;..z:...~..
<br />.
<br />;
<br />~:: n•~/
<br />
<br />
<br />L ~~ ::. ~i ~:a~~w ::
<br />'L1(';, "rif:tL SAMPLE ... i ( 1
<br />,:-, ...i i`,.,) MEASUREMENT ,~C, ,L ~j ~ ~/J ;_?.p[
<br />, 7 ` L J D "~;;PERMIL'~: :~~ •;r;~.<y!~^<
<br />
<br />~ ...•..:..~^r.,.+r .3
<br />
<br />~ ::--~: :...::.~•~.,t~:~~~~::>; .~
<br />5'
<br />•~ ,z~;:<,::~~::~:•:~
<br />
<br />i : :~:a~:'.><.y ~ „ .
<br />''r'L"r. '.! ~B, 55 Y3LJ` REQUIREMENT '. ,:
<br />~ :
<br />:. ~ ~.::~ .. ~.~ 3 J AY. ~'1k ~'~~
<br />~',:.11~'. n;/!. '~ l~10.3d.'[`'
<br />i.i7', ;iifTLEAFL•~ SAMPLE
<br />MEASUREMENT ~;::.•:.... ... 7n.n aaao:~,
<br />C 25
<br />( )
<br />~/
<br />GI~AI~•
<br /> .
<br />Q, ~ 3~
<br />. ~'! 7 D 0
<br />::.:
<br />~;:: PERMIT-T:;:~: ~~'#~~iy.Pc a: ~ ~:. rt
<br />;%;~y: 4:^.. .:k.(ew~,erY.; _. ~°::.p:4.ff;; is .... Q.. ~.
<br />
<br />
<br />:. ..J...:,I H.LU,I
<br />REQUIREMENT:
<br />~.~~:.:~ .:. ... .:.:.
<br />~~~.:.:. <:.~
<br />. .. .. .'~~~~..~~: .
<br />..
<br />.~
<br />~:~~'~~:~ ~: ~ ~
<br />
<br />~
<br />
<br />~ ~
<br />
<br />
<br />.
<br />
<br />tY#a:~i.A!:~~~tf~X~~'
<br />
<br />L
<br />kL/
<br />
<br />
<br />
<br />?::3;
<br />'
<br />
<br />W''':5
<br />~If7
<br />.
<br />i.7 ';, :~`:PTLE.1i L: SAMPLE zr nrt:: '- ... ,._ ~...~ ..y 1: :4*• ( 25)
<br /> MEASUREMENT ~~ ~q ~ 1~
<br />.;'I _, L .J p :::;:<.:"PERMIT:::. :~.•.:est~tc2r'.'F+:. ;'... ..~,:.,.u,4tac tk yx...
<br />.:
<br />~ .. :•: r.{:
<br />
<br />,.
<br />x .... .t-i~-
<br />
<br />
<br />i .1?.; ~~j~;i'[
<br />
<br />
<br />.
<br />:~~
<br />
<br />
<br />
<br />,
<br />i
<br />~~
<br />:
<br />~ d c
<br />
<br />t,
<br />
<br />~::-r d"41' GRJSS YALU. ;REQUIREMENT
<br />
<br />:
<br />:>::..;.. ...:.
<br />~
<br />..:.
<br />
<br />::
<br />
<br />...,
<br />~
<br />`::4~t~.i[ x'4
<br />::
<br />
<br />
<br />./ ~
<br />
<br />.
<br />:
<br />a=
<br />
<br />:.:
<br />.
<br />.
<br />TH
<br />:.~S1N .
<br />. ~,,
<br />. ' d '. , ' ~: Y F. I~ R q L S SAMPLE
<br />MEASUREMENT r.+ry>:': ..
<br />L , e) ~.
<br />O, 1,~. ( 7.9) ~
<br />~
<br />3 31
<br />(x.'-.'.~
<br />..• 1 ) D ;~~:~:~PERMIT:'7~,:: ~~; `:.-.~`,T~a.?k~# ~::~ ~'>`:~..},r~C~xypeti~t ~ ;:::,:- °. h~tarkrpg 'I,. r' -. ~ .~tl~r'?=Oe3:'!' ~ ' K~.IC~;:'/ :.' A •
<br />
<br />.. ~J .~. .; it)~5 Y~LU REQUIREMENT:
<br />';;..:.:.•„:....:.. '
<br />:. :::::`
<br />:i;:i::•.::i..
<br />:trt;••
<br />
<br />~
<br />{;~;.::; ,tY'J
<br />~AI`i.rY. "•=
<br />..;;/L ..
<br />t!:U..lT,i
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1Q""T" °fP`""r°~'",n., m
<br />prep.rttl °"a.. m> air..n°" °. mw bewmem .na .w nucn~nry.,R
<br />.•~+°" ~" .comn...un . gnem ad
<br />n.a ,
<br />.
<br />' TELEPHONE DATE
<br />.• ~ ~r_' „
<br />.~ ~Ji'1., .`,3~;,IQ". 1`-Ch r
<br />mavurt,na qutllllA wmnnelproprdr P~ner.M enN.u,b lnfomutlon
<br />n .~•' •~~
<br />~.
<br />/
<br /><
<br />.
<br />St'.r`f1C"_ ~
<br />a-
<br />+'A'
<br />?!
<br />"
<br />~ ,°
<br />mm.e. esaa en m~inqulryar Newwnwpemm .na m°nq. Weapum.
<br />°rlna.Fernwah«,N~ro,pw.tas.mm.tu.I"r°„n.u°n. m.mr°.,".n." r
<br />~~-a i'' ~ : ;/ i~ •~-~~7C1g
<br />
<br />~~
<br />~
<br />~
<br />Rp~~;~c
<br />NnMU.ai..:om.ee: or mr tno.kap ud wu.c:ry...a.:,v...na..mol.:«
<br />I .m °wm u., mrne °n tl
<br />Neom
<br />ma f
<br />n
<br />i
<br />hb i
<br />m
<br />r
<br />
<br />610NA~lIRE OF r111NCIP Q/ f~ f
<br />
<br />•:~~-N1-•RYPED'I'1R'TRINTED°.'"•:'-"~- _~'' t
<br />wn.
<br />or w
<br />m
<br />n
<br />t
<br />n
<br />omuY°",
<br />Inafual"i:M poaannlq ornM.M:mpnwnmenl forYmrl"t •Id.u°ix AI EXECUTIVE
<br />OFFICER OR AUTNORI2ED AOENi
<br />p' A
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />_ ..... ... _. ._.___ _ CODE
<br />e~mmcr.... nnv ~... ~.,...• ......... ..... ......• ~ ~...... ,n.rvmcn,.n .u.°nn..nm n.rq
<br />~., ..F.T6~ L['L."_ h'~ i.: ;t:TTi.~A9L. S~i•in• (! ")'! I=^LI' ,•,LY ~ .- 1 -. •'. '1-'i' 'auBCIP £Y: r.
<br />_aI'+eaq ~:.. i.o.4, P. 9, F)'; P.U:Zf'"V '?C Pi:07F' il~,'[II°G.?F~'~. J=.. ,.-ir" --. T. ~.1q PC. 17..
<br />D ~.
<br />EPA Form aazo•T (RCY 3/99) Previous edllions may be used. ~ I 's ~ 4. arl~Corm. PAGE of
<br />
|