|
Fprm Apptprod
<br />FERMITTEE NAMElADORESS (7. lrYtl h'w'Lrra.VDIOt•'°~4 RATIONAL MIIVTAM OrKNM011\ILlO1AYlOM lYfSpl (N/'(IESJ ~.~ z~'~+
<br />HAMS - OtSCHAROE MONITORWO REPORT (OMRI
<br />., .. ...
<br />ADDRESS. -_ ~' (': ~ %P it Y.)
<br />-. ~ ~ _ PERMIT NUMBER ascNAAOt Nwlltw _ P I tE ~ ;, L t "
<br />.. .':vii/:: .. - :i~ .. _., _T._. :.
<br />FAntm :: LS t1I A E T MONITORING PERIOD ~ .!~ -
<br />YEAR MO DAV YEAR MO DAY
<br />LOCATIpN .. ;' Oli :.O 1' E FROM To ~-__- - - .. - ~ ~ ~ '
<br />• • r n' A n n T -^. YnY . tl V Y t?:t NOTE: R..d MtlucHorr A.tot. compMthtp tlli, tam.
<br />
<br />PARAMETER Ot1ANTITY OR LOADING QUALITY OR CONCENTRATION NO. tR[OUt»cr
<br />or SAMPLE
<br /> EX TYPE
<br /> AVERAGE MA XIMVM UNITS MINIMUM AVERAGE MA%IMUM VNRS ARM.Y95
<br />.~ SAMPLE .. ~- ~ ~~ ( ~;
<br /> MEASUREMENT
<br /> PERMIT-- a,ee;+~a - ~ :~-,~ ,, .5 .boa3n 5.L' =c~L7 >ti~,*n
<br />„
<br />~ REQUIREMENT ~ - 1lIYI!fUM !fAI I71U;S _
<br />--
<br />----- r~r 1„
<br />, SAMPLE .'~~= ~ ~, ~y rr.~ I _
<br />;ED MEASUREMENT
<br />I U U PERMIT Ac t•os,o Ov .A40 S~ - 40G 461/ !'1 i t NC`-! ~ Nn"
<br />•'L1~<S :iRJS5 Y~ .' REOURtEMEN7
<br />-
<br />-- -- ?IiU,I d7', ^I( 70 l1Y ~ •^('1~_"••; _
<br />- -
<br />', S£TTLBA,+, sAMViE - ~ ~
<br /> MEASUREMENi
<br />-. I 0 U
<br />• PERMIT Rsao:: :•onraa a .^ Ao r, 7 0 2: i:pOF ~ '.Ce/ ':h d'.
<br />.•:~.1T ~HJi`' Y.~,.
<br />°-: REQUIREMENT -
<br />'-__ PALLY ^X p~Mr,'
<br />, ? n L SAMPLE ~ - - o _ _ ., ., f~,
<br />_
<br />(A5 f-_:I MEASUREMENT ~
<br />1~ _ _ _
<br />
<br />i. iJ~ j 0 ~
<br />PERMIT
<br />"o-:4:v
<br />yta0 o0 a
<br />i~ 6!
<br />,•,
<br />~
<br />..ii _
<br />:. =:/
<br />n.tl
<br />:Pf'LJBNT GAOS~ Y%.'„ir REQUIREMENT --.I l7 SGD6 Y_ DACLY !tY :!: `GR23
<br />:L 39D ~HQAST SAMPLE - .. - ~j r ~ -~ ;
<br /> MEASUREMENT ~ ~; •
<br />1~tl2 1 D U PERM17 ~R?UO n . _ :o ^ ttte ?PACK' i - ;!Aj
<br />;f'9'p•:PII CAQ3i YAL:i, REOVIREMENi ~ IY;t' °AC r ~ll.
<br />-~• r $ CD ~ SAMPIE ~ -
<br />i r-..' S'aLATl1L>1T PL'.- MEASVREMENT
<br />"~~J 1 D U PEnFn1T- REPORP itYPakT Ooaooa oo•: oa a ae.T ~ .. 535Ar:
<br />1Li~
<br />OSS V
<br />'
<br />:
<br />1:
<br />~ REQUIREMENT 30D
<br />w Af
<br />: DAIII d(x '
<br />~
<br />.
<br />~:Jh
<br />T
<br />R
<br />r .
<br />,
<br />. o.ASF. SAMPLE -•u 's~ ( -.y --~- ~•-. x - ..
<br />.~ MEASUREMENT
<br />-
<br /> PEA MIT .. T c. a -r n - `-~T ~s
<br /> REQUIREMENT ~ /
<br />NAMERRLE PRINCIPAL EXECUTIVE OFFICER '•"°' " ""°""
<br />W.MmlurlGr,nr dna~>w.n•vp "'°"""°"""`°°"""'
<br />rMew ln.[v".Wnr.lb °v°""`
<br />..)gTYM,wC l l,~
<br />l~
<br />f
<br />( ~
<br />' TELEPHON E DATE
<br /> N
<br />.
<br />.
<br />I; I
<br />
<br />~ ~• % . r le M.Yr. LW MMIhJ P•w.u1 ,n}.T (.O.r W .•w.l. IN Inrn„bIIM
<br />...e..,
<br />w.n..a .~...., :.°.•,. w Iv
<br />,.,,..A. °wa. w a+•.. ~ ! ~ ir'
<br />/~ c.~.: ` ~ ; 9" _
<br />~•' ;
<br />_
<br /> ,
<br />p
<br />.
<br />er IhOV Mn`ti Arw.h rn,a.Ar M (N°rnq W bAv+"rIM, nu MfvwN1M
<br />Vj~!~ ' f /~/ '`
<br />l _
<br />
<br />`
<br />~'
<br />~,~
<br />//~-r MU°.r"dd blP.~ll.~n•\w..116P ."t TIbIf IIY .f[Mnlr..M rl~.IIN .
<br />~
<br />`
<br />. u
<br />.rlh
<br />l
<br />hr
<br />1M.IW
<br />I
<br />J
<br />Y
<br />M
<br />l
<br />R HORATURE OF -RIAOAI EXLt:UTM
<br /> rr.n
<br />.r..n
<br />~
<br />r
<br />yu
<br />n
<br />rhn
<br />M
<br />rwbyy
<br />.r
<br />r A
<br />TYPED ~ -RWTEp rR+.a.t ur p..Mai, .r.r ...errynswn..r rm tpnMt.M°rlnra OlI ICER OR AUTHORIZED AO[M hNMEEA YEAR MQ DAY
<br />COMMENTS AND EXPLANATION t!F A.nT vrVLA I IVNS Inn,rmc, M,rr,cnm.nra n,lq
<br />., C HEPOkTEa. OIL L GREASE. - 5HG I.°.1 •D, P. 9. T55 6
<br />- _.. '"IDS LIpiITS 11PPLIED PAR :=I~7r3,2uHii PRP•CIP EY2SiT-5£TT.
<br />evA Form 1.Tt0-, (ae. s>+~ Prtnpln ee~ppm m.v ~ N+pe 0 0 I 0
<br />
|