|
FERMnTEE NAMEIADDRESSpb+fwWyN~/1x.ua. yDrp..wp
<br />NAME J~ ~ .`r. Llin.. .~.',r ;.',Y
<br />ADDRESS ~ h ,~} w . h I'
<br />96YJf[. ~J H1e+37
<br />FAal.m
<br />LocAnoH:1 n Y J E' 9 L .. . 1 J J .,
<br />NArIONK P°LLI7TANT DISGHMOE [DMINATIOM SY4fEM /NPDESI
<br />DISCHARGE MONITORING REPORT (O Rl
<br />rr i`N1r1771 ~11
<br />PERMIT NUMBER ^~-K -dxll)w°F NDMeER
<br />_,.>~`
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ Q.'~ D 1 "TO i_) ~ u •J j C
<br />,.!•
<br />'.i J
<br />(,,I;vK ,y G)
<br />' - °IIiAL
<br />kC~CT.
<br />SSD. POND DSCC`I T(1 ,RASPY CH'r;. r
<br />"~~ r0 DISCHAt: ~ I~Q ''''`
<br />NOTE; Rrr~d Imtluetloeu Mla~,eompMtlnp thh farm.
<br />PARAMETER QUANTITY OR LOADIN G' a QUa~ 1 Ly Or Concentration NO. p1fOOF1C1' SAMPLE i
<br /> EX TYPE
<br /> _ ,WKrya
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />2; SAMPLE . .,.. Rh'::u •; ..... ( SZ)
<br /> MEASUREMENT ,..
<br />
<br />i
<br />~,; t L U 1 Il ;. PERMIT.. : .. .. ..
<br />; _..:.
<br />
<br />.
<br />
<br />:3:;~
<br />,
<br />
<br />~.;~i~...: .~~ ... :... ..:. .. _
<br />..
<br />.. ... pEQUIREMENT. ; ~~:~~ ~ ~... ~ ~ .~
<br />
<br />ys RSYd .,A
<br />at ..
<br />~1$: .
<br />~: _~Li~r=, "r~T4L SAMPLE ..:.,:., ;r ;:. ;: ,. '. ,;: ~<a Rtr4C+D'k 19~
<br />~
<br />:; i; .~ ~ ; ,~ c ,,• MEASUREMENT ~~
<br />'~U71J . J U ..::.PERMIT:.. ~:.',:-:.:,: .. :.
<br />. :.. •, :.: •.~::.;z :::', .. ... .~yal ::
<br />
<br />
<br />4aix .. _ ..
<br />
<br />
<br />:
<br />,
<br />f
<br />
<br />
<br />. ..:...
<br />-
<br />... .', i:~r::d/ 5.1
<br />
<br />'
<br />a
<br />1', f'[•i. I!L': ( Gy;/S5 4. LII REQUIREMENT. .
<br />:. ,..
<br />.. .: ..' ~ ^...:i. , ...
<br />~ !~.I~::~G '.~L: ~::;:. .......
<br />'•:4 'tG/1. 'K.,'":KT'I!
<br />5~.:.L',. :i
<br />,~ b'CTL~Ad:,E SAMPLE .. :: a aVOC4'i ( ~ ij'
<br />, MEASUREMENT
<br />`
<br />I, ~'~PERMIT~ .. ~~..~:: e.:.;,n .:.: ~~
<br />. •~: ... .._.:.
<br />.. .:.
<br />
<br />. ... u"..i'p.,..`:,: ,.:;I.j. i':~...~ ~: ;aY l??/ ;:?F. ~.
<br />
<br />:•.•YL I=.:i +.:d0.i5 Y,11. 11' REQUIREMENT
<br />:.:: .. .. ~' ~ ~..
<br />.~ .: ..
<br />.. ....
<br />: '•
<br />r,.r;
<br />
<br />:'h .
<br />.~t.^".:
<br />
<br />
<br />.
<br />1!1
<br />/
<br />t•u
<br />
<br />....
<br />:
<br />i ~17a, C0T6L SAMPLE :. ;.• ...... .~ ::~..~:~:.. ,;} ~,{:#a , ( ly)
<br />~5. F,c~ MEASUREMENT .
<br /> PERMIT ., ..:::_ ~ ~ .:I ..,y:.: ~:. ~
<br />_~
<br />~ :: ;r..4 i:~
<br />..
<br />~~~~r i. I~.. '1' ..Ha iS Val 11 i REQUIREMENT
<br />..... ~~... .. " ~
<br />..~~
<br />~
<br />~ ~'
<br />',
<br />.1r:'•'•
<br />
<br />~
<br />w;:/l.
<br />~a•':~.~
<br />'
<br />JSL f, ..? ~KEASli ~ ..,.I. ~. .-. .. ( i9)
<br /> MEASUREMENT .
<br />'J S ~ d l 1. J U ~'~::'PERMIT... .... ~ '::.;~ ...~ .,:.,.: ._ .- .. ..: 4`.I:r: ;..1; -. ~'t ~ .
<br />:rl.';H:•:r .,ao•;; val.cl .REDUIREMENT .:: ::. .. `;..:. -:..:
<br />...~.:
<br />
<br />.
<br />
<br />... :'.r
<br />,
<br />
<br />,
<br />,.G/L +,. a; y:
<br />r LJ+, i Y ~7R'JUI'" ,o SAMPLE ~ r, ~j ..:.._......
<br />~-.~~ .......:..... . `.
<br />;,
<br />''.I r.'1 Tr•'~.° C"!$YT PL.q fi, MEASUREMENT
<br />'„J;I~J 1 ') 1 ::.. PERMIT.... . Y:. --..: ..
<br />;: • i[na ,.. -... :;:#
<br />~ : :i ~.:L~'`f r!r~:9:
<br />.
<br />L h' E L •J c ', C ~ d :J S `~ ': A L U !REQUIREMENT .. 3 ,... ,...1 4 L, .
<br />..~ ~.. •:. 1 ~ ~ sr~>1al •;~r1A'" li
<br />.':JLI'~`..:, :JTAL SAMPLE ... .. .. ;:~ .. ... ~ lyj
<br />I: L ~ .i J L L' . ~ MEASUREMENT
<br />: r
<br />/ ; ~ v i L ) U ~ PERMIT ~r
<br />~.'.
<br />. ~
<br />~~':.: ,.. ..
<br />~ ,:.. „G ..
<br />... ~ x
<br />./..~ ' ...
<br />i+l~ •c ~ ,; tt
<br />..L.T
<br />ilA !+
<br />',.: ~ ,. , .
<br />REQUIREMENT. :..,
<br />~
<br />NAME/TfrLE PflINCIPAL EXECUTIVE OFFICER I «^,y • r pens lr o l.. Ut.l Nb tl«v„enI nM .II .II.•I,n.nU ..«
<br />PnpuN uMer mr alremlon er wpenbien In •aaerd.«e .Ilh . a)alem tldFrtd
<br />~ - TELEPHONE DATE
<br /> In.eum lb.Iqu.IlnM p•ronnalpmp•A•,.IM aM •rrlu•1•Ine lnror,«Ilon
<br />wbnallrtl. Hoed on m>InqulrrNNe p•ron«pervu .no m.n.re aM,Tlrm, 1~ \ /
<br />/\
<br />//
<br />\
<br />A(
<br />\ ^-`
<br />W ~Q
<br /> «m«• pro,n m..<ly rupmWD4 tar pm•nrq rbr Inrernuna,t m• fnrm,wlwn _
<br />h
<br />`
<br />`
<br />(~ w i
<br />
<br />wbmlled 14 b In• npl nr m• Ym.Mp.na p•Iler, Irv, w.yr.lt..M mmplele.
<br />Inm...nu.unma«a
<br />mnrm
<br />mnm
<br />r
<br />b
<br />llu
<br />n
<br />a
<br />r
<br />\J/
<br />•IDNATVIIE OF P111NCR'AL EXECUTIVE ~ ~ ~ (~
<br /> ,
<br />or.n
<br />m
<br />na
<br />e
<br />n
<br />nr,,.uon,
<br />F
<br />l
<br />I
<br />TYPED OR PRINTED naWlnt lne pamblpy orn«nnd lmpNwn,wnl r«bm.ln~.la.ue,u OFFICER OR AUTNORI2ED A°EMT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION Or Anr v1oLA rIONS lRnArrne~ N/ aVfsAm~nts hrrr~l
<br />
<br />_ ., Cr.Jti LL.'I r' n: L;, .;::.. ., r.,'. .;~-....? .. ;UL:.. L-.I, .. ...:. C=i')Yd., 24 nS Fn4=Iu o4t; t.T; T:i 5
<br />::,J:, LI`+..TS .AIlFa > ;, -', ;7' _. ._ li ~., .. t' :IC,: I', I.. r'LL 6 i;ai.ASE-SE'::
<br />i~v'~ 1~'f ovi i'.'.".I: Jr :,.:
<br />EpA•Form•aazon (Rev3/99j'Phevioureditioris may be Dsed' ~ ~ ~ This.is a 4-pan (olm. vnaE of
<br />UOJ4w/JUu/11-bola 1
<br />
|