-ERMITIEE NAMElADDRESS p.++~~sr~.X~[erw.. yDl}~..wJ
<br />NAME _ .
<br />ADDRESS ' . '..
<br />.:o,l,rf dGAI: o~
<br />Lf CO 4164
<br />FACKITY .~ ADS dIRL
<br />L~T'a+ LT CL' 6164
<br />J• lilLi.AKU~ rlI•~t8 P1AhSG6&
<br />NA,~~DISCNAR[iEdMO~F! TI OIRI~NOWREP~ (OMRJ~FSI
<br />PERMIT NUMBER psnuAOErws[A
<br />MONRDRfNG PERIGD
<br />YEAR M AY YEAR MO OAY
<br />FROM -~ ----~ ----~ TO
<br />/«m Apprrr.e0
<br />ONIt{NO °WO-0f)Da
<br />ri++LJx
<br />(SUtiK J~}
<br />Y - PIKAL
<br />SC:t: SfO: pOt..I'G P''D 11hSi:
<br />NOTE: R..Q fewlt~ctlanA pN«. oomvMtkrp thh loan.
<br />PARAMETER lN1ANTITY OR LOADING QUALITY OR CONCENTRATION NO. rA[11~F^~`' SAMPLE
<br /> E °y
<br />
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MIMMUM
<br />AVERAGE
<br />MAXIMUM
<br />VNRS X µ~
<br />yi TYPE
<br /> SAMPLE
<br /> MEASUREMENT
<br />• PERMIT -::c> .. - 4.: o_.c •.. '~..J i:' l - .. ,. ..
<br />_ REQUIREMENT - n j p r u- !3 A Y I IIIl
<br /> SAMPLE _
<br /> MEASUREMENT
<br />. .- PERMMT .. .-,, . -, J`. ~. 'ham.:/ ._
<br />l.i ,. REQUIREMENT s'Jd bVG '!1 ?~ A'r *_%!.T".
<br />~' ` • i .. SAMPLE ~ _ --
<br />(A. i MEASUREMENT
<br />...:~ 1 PERMIT ... . .. - .. , ...... c / -__
<br />.. c.H7 REQUIREMENT
<br />- .'JVA t. 'r :.]
<br />... d}U '.. .. .. SAMPLE
<br />MEASUREMENT .. __,-__.,_
<br />.._ 1 a PERMIT s: e.=~. ..: d•.u~- GAcc ~~. ~c. ~9a<- _
<br />_ __.
<br />r L ' :. :.': is P. ], .. RE~UIREME~T ~;:
<br />
<br />. ?tiATQEbT . MEASUREMENT
<br />--
<br />--
<br />-
<br />- 1 U U PERMIT - .. ::~. _- - .
<br />. . ~ ~ T G It liS ~ REQUIREMENT ~;; ,. ~. :.
<br />- J--_ .
<br />-
<br />-
<br />... r .J • SAMPLE - _
<br />s,/CP MEASUREMENT
<br /> ' - -_
<br />1 I! ,! PERMIT +*`•~a-7 :.:aa a:. OOU ~
<br />ua RL V~ . -
<br /> . .
<br />. _ - iinT ~fiUSS '. ' REQUIREMENT
<br />. ___
<br />-
<br />_
<br />.. :.AILY ~~
<br />_
<br />__ .riv ,, ,. tom:. SAMPLE _ _ ,.
<br /> MEASUREMENT
<br /> '
<br />04 lTjeG:L tai: r.o
<br />PERMIT '••~ •• ...r.. !. f:~' 7 S1/t
<br />... REQUIREMENT - - ~ : L
<br />NAMERITLE PRINCivAI EXECUTIVE OFFICER ""°'" 'r•"• b- a« uH p~,r.~.e,...,.,..... T
<br />EI
<br />EPHONE
<br />.
<br />e
<br />r
<br />DATE
<br />I
<br />.o..
<br />..
<br />.
<br />..-: vn.,M. ,, w,r.n.+u, i. ...u. n..awp.a
<br />~
<br />Ie .wff 111N (..MAM M.r^M 1~.9.N1 (uMt n.~
<br />W4 2e MIM..,YIw -
<br />..~0/„N .wr M "r) :ltvln O( Yv ~...ln M Y~Y~,. .b M•,..
<br />e Ib
<br />Y
<br />~
<br />1)
<br />I~
<br />.r l.Mt P.r." N-T!.. n•M"~1M• W /•IIVM[ N• I.~Te,F1,\ W IMn,rAM '~- ~ -
<br />rM.AM h .o Y~• M•~ of w,. •.w.W~. •M NWf. ..w.. rr..,.•, w owA1,tr
<br />ls.-.nn~..a...•n hnlNrt l•,,.MIn M1•N"Ne,{r•.•1NnalM~
<br />t10MATlAM OF lMIINCIAI f.[(CURV[ -
<br />TYPED OR PIiRITFD ,
<br />~Y ~~" frtln~t .u ~"' •.6 ~.ona..,.,. W •r.ver ~M.M1aw DFFiC[A OR AUTHDRlj[D AO[NT A A NVMBER YEAR MO OAY
<br />wNM[en: a n nu c w......... ~ ........ ..... ...,.........~ .n....,.......... •.,.......no .....r
<br />.. .... ARPLZli:. I±-5TR0C7:ON3-j.C.S, ?i+ d.
<br />eoA r«m aaxa: IRe. as9. a,.rwus aamoAS rvy t» u~aC n 7 y, _ ,. Thls .N a,~ ~ farm vAtTE OF
<br />
|