I'ERMITIEE NAME/ADDRESS QriiFrNryN~/lxrla, /Dlpfww,q
<br />NAME Si,IrL•:;. CiiAL '
<br />.;u: ~xs.i
<br />ADDRESS (` ;{ rt 'n I_ L
<br />rl;:YD1:1! Cv Fir.ja
<br />fACILT'
<br />xAnoNDISCHARGE MONITORING AREPORT (D lRIPOESI
<br />PERMIT NUMBER , ~`"~N" gSCNARBE NlMSE11
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 0~~ Q7a.~.Di TD ]i, i14 1U
<br />sw,. .~~
<br />I:.~•
<br />!' - ?INAL
<br />
<br />Fcure yet TBSTI;+G F]i: Oi31.
<br />aaa:NO DISCHARGE' ~ra.
<br />NOTE: R~~d Imtruetlorr Bdor1•eompMhq thl~ form.
<br />PARAMETER QUANTITY OR LOA'DIN Ii* ~ quality Of CGncentr~a
<br />ti
<br />on NO. ~EOO DID SAMPLE
<br /> r
<br />_ X ANAlrse TYPE
<br /> AVERAGE MAXIMUM ~ ~NITS MINIMUM AVERAGE MAXIMUM UNRS E
<br />, ~~ •t '.> ; r,-.' 4 ~ ~
<br />.... ,~. : ,i .. ~.: SAMPLE ., ~. ;. .: ,x ....: .. ..
<br />t:.
<br />-::,: ~. .:-.
<br />...
<br />`.: ~:);up 23~
<br />L J D H F"
<br />l w I
<br />, MEASUREMENT
<br />r
<br />_ ;; a
<br />. ~~~
<br />:a"
<br />l:~ 1 •J V :PERMIT
<br />; .
<br />::.::::::~-.-: . .
<br />::.:: ,..:~ ~
<br />_:
<br />~ 17 u+~~~_
<br />:
<br />:: .. ,Ea_ :~ i'S".IL Y ;; A:'
<br />.
<br />"r'}F1.1!•.'I i' :v:lti `; V]1I .
<br />....
<br />REQUIREMENT: .
<br />..
<br />: ~ ~ ~ ~
<br />~~ .
<br />.
<br />~ ~ ~ ~
<br />~
<br />~ ,.
<br />~ '
<br />r,,;:;kp.~ .
<br />.
<br />r
<br />Y.. .a ~i.r ~•. u.:
<br />~
<br />r~-~I:T
<br /> SAMPLE ~ "'~
<br />.
<br /> MEASUREMENT ~
<br />
<br />:....PERMIT: ~~..
<br />~
<br />... ~ ' ::..
<br />..
<br />....
<br />:
<br />.. ,. ~.
<br />
<br />~
<br /> :REQUIREMENT. :. ~ ~. ~ ~ ~ ~ ~ ~ ~ ~ .
<br />~ . ~.. ~ ~ .
<br /> SAMPLE '
<br /> MEASUREMENT
<br /> .,:.:~..PERMIT~ ~
<br />~
<br />~ ~..
<br />~~~
<br />'
<br />~ ,
<br /> REQUIREMENT. ~. . ~:.
<br />::
<br />.
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ~: ~ PERMIT ~..: . ~ ~ ~
<br />~
<br />~ :~. ~ ..~
<br />~ ..: ..~
<br />~~
<br />~ ~
<br />~ ~~
<br /> REQUIREMENT ~.~
<br />~ .: ~
<br />. ~ ~ .. ~ ~
<br />~ .. .
<br /> SAMPLE
<br /> MEASUREMENT
<br /> :~.:^.~::PERMIT~ ~ . ....~.........
<br />.. ...
<br />... ....
<br />..
<br />
<br />~REQUIRENIENT~
<br />. .. ...
<br />~ ~ .
<br />. .
<br />..
<br />..
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT ... .. .... .. .. ..
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ~~ 'PERMIT ~ ..~ .. .. .. ... .. ~ ~ ...
<br />..
<br />...
<br /> REQUIREMENT ~ ~ :: ~ ~~. .. ~ ~ ... ~ .... ..
<br />.. . ..
<br />
<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER , rtmy u er prnu IJ n o Ib,l 0
<br />yrtp,M nnarr m~al.rcllun urnp h Eorvmrnl and tli.llKbmmb Wert
<br />enhlwn In rmrdumr wan „
<br />arn xlrl
<br />ned
<br />TELEPHONE
<br />DATE
<br /> d
<br />p
<br />to mart Iba quullll,a pronna pmpear plbrr uM enbule IM Infamulbn ~
<br /> mbMn,d. !dd on mr Inqulrr a IM gran a prvu who mnup IM rynrm, ~
<br /> wr IM1Or prrom Elrrcllr rrpoNbM fr pxbeant Nr Inromullm, lbe Inrormllon \ _ l \
<br /> mbMUed b, to the lul or mr kmYdre nM Mllef
<br />Ine
<br />r(VnIM1 unE rom
<br />lele / ~ ' ~, Z
<br /> ,
<br />,
<br />p
<br />. •E
<br />E
<br />r
<br /> I,m,vn Nnl lbm art arwlnoa pmmr br rvbmlmnr nbe bformutlan, ti1ONATURE OF -RINpMI
<br />X
<br />CU
<br />NE A A
<br />TYPED OR PRINTED IMUtlIn~IM pmdbllllr ulna uM lmpamlmenl fa kmwlnr aaulbls OFFICER OR AUTNORQED ADENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EAYLANA I wn yr nnr vw~w I wns Imm~nn sn ~rrecnmmra n~nl /
<br />..ct' rAirT I.~4.~i CJ:: Jl.1MI~': 7.' _.._ ~ r, ~~:UJr.. ?`~F'ih.T i.CeES•I' i)ILUTIUb (:. •'"r'..,:_ :) GHICH IS Lf:Ttl~.L C•'. •~1~:.
<br />;ir .....1 OhGxlIal~.'t:i (LC:,C) ,, .: ., y'i..,_d :._7'F _"1Y,I^_7TY iE~T `'-F03T fOr:, :J ::,i.
<br />EPA Form JJ20.1 (Rey 3/99) Previous editions may be used.
<br />ODU60I JUij.~S~a 4-part foj PAGE IF
<br />.~
<br />,zL~e ;
<br />
|