KRWTTEE NAMElAOOtIEiS p- .. l.~yr~trr.. yMp••W
<br />A00I1ElS•`t1 tt::: '-A::Y ~•)i: 'i LI
<br />FAL'ILfTY
<br />lOUT10PE,.,'.n l,i y~'7:7
<br />.. .. c \ v
<br />-- -'._-- ~-- - -'--- _ -- -'--- Form Appro+ea
<br />MATfORK IOIIVTAMT (MS[NNb1 RNMIATON ('/ITEM INPDE$I ~~ ~ ~4~t _ r
<br />DISCHARGE MONITORING 0.EPORT (O R1 n T :r J 4 e
<br />PERMIT NUMBER asarAAaewea ~' - h~ i :. 61. G:~, ! L!7../
<br />r
<br />' Y.: , i, ; ~: 0 D :: C t: G "i; :: C r: : ,' C :!r: F: 3 ~"
<br />MONITORING PERIOD
<br />Y AR MO DAY Y AR MO DA
<br />FROM TO °"'' ti? 1i SCi'.A P.':E ~ ~ .',n
<br />-.. z _ z t t NOTE: RAAd Inetructlar Mfae tomplelinq lhb lam.
<br />.. , ....
<br />. .... J . , - . . - , . .. _ _
<br />ET
<br />ER
<br />A QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, t"!0~"r
<br />m SAMPLE
<br />PAR
<br />M EX ANKYAS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />:
<br />.:
<br />:
<br />n SAMPLE
<br />, .. .~
<br />.. ...
<br />.
<br />.. .
<br />' MEASUREMENT
<br />:
<br />r L - ~'
<br />--Sb~$ ..:
<br />a Y
<br /> ap
<br />~
<br />- :
<br />`~
<br />:'n
<br />1~
<br />; , _ I u : + . K '~
<br />,t,', , 1: PERMR
<br />REQUIREMENT ti
<br />ne
<br />'p :
<br />:
<br />K
<br />;1 !ISx !'IA>t. .
<br />:,c it °..) " ~-`. .'.•
<br />tft:; . '^,,:• ^J` $'.r jj
<br />rv~ij
<br />' t 1. i1 : . i . r , ...
<br />t
<br /> SAMPLE
<br />MEASUREMENT
<br /> PERMIT '.. .' _ rr•
<br />~ __ :.
<br /> REQUIREMENT i ir. ~ ~' ! - ~'• r -r'. ,.:.~ .{:?.~"~T 4• ~ ~`~ t'ur -
<br /> SAMPLE
<br /> MEASUREMENT
<br /> _
<br /> PERMIT ~ ~ .-,.. ~ -
<br />i9 r'
<br />'
<br />~ 1~ '
<br /> REQUIREMENT ;,%• ^ .p.
<br />_ ~_ .. • .j
<br />.
<br />'
<br /> SAMPi.E
<br /> MEASUREMENT
<br />
<br /> . ' ;.. .
<br />~~:, f \ ~ 'i:-','l::
<br />'
<br />-
<br /> REQUIREMENT r .'+ rT ~ ,.'~ _ J,.r~ 1
<br />, ,
<br />.
<br />
<br /> SAMPLE
<br />MEASUREMENT
<br />
<br />
<br />'
<br />f
<br />a
<br />t
<br />'
<br />Y:
<br />. s
<br />i' `. '~;
<br />~.
<br />'
<br />'
<br /> REQUIREMENT 2;-
<br />',c. yy .
<br />,dJja \i\ ;~ _ y
<br />~ ..y
<br />r, _ : r
<br />_'In
<br />R
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br /> - PERMIT
<br />'
<br />~ ~. .;
<br />. - ;..~' ...
<br />r .
<br />t
<br />: _-N _ .,
<br />" , ~'
<br />' ..F,til
<br />^l` . Va
<br />.
<br />.
<br /> REQUIREMENT ~ !
<br />~l ,'
<br />jrN
<br />, L ~j
<br />,Yi a ,
<br />1, IaAA . ..
<br />^~ ~
<br />~y\.V..i,
<br /> . V
<br />.
<br />
<br /> SAMPLE
<br />MEASUREMENT
<br />_
<br />PERMIT ~ '
<br />REQUIREMENT ~ :
<br />.
<br />_
<br />NAME/TITLE PRINCIPAL EXECVTNE OFFICER ~"°"~~~T...n. nn w.'., ..a a.nr\...u .... TELEPHONE
<br />,..,...a. ., ~,... o.... wn..u..» w.wa.....ra..ni.w brow DATE
<br />......,.' e~.a..~.,,q..,..ru»I......,..,...4.»..e. n.yw.w
<br />L
<br />~v
<br />.
<br />L
<br />! r.\vp...~.ni~..~,r...r....14Mt.,..ny rw .Mw..uw. a»,.h...rr. % = ~ /~tJ 1«-Lf~;.~
<br />' ~
<br />I~. { f w\M,Il4...~~••G.1Mn.,....YC(..rdMM.,n., .[.MYI. ..~[anFY,.
<br />f{IONAfVRE OF M7MC/•Al E%ffttTM
<br />w
<br />n
<br />r.n.
<br />an
<br />r.~.-...q.r.n.i..,.MI^'m.., M.vv. r.. w\...e.trm
<br />~11°'.wn...,.t iw,..~...r a. ....», .ww... O!lICER OR AUTHORI2(O AO[Ni AOOE NVebER
<br />»
<br />\.A
<br />'r+ YEAR MO OAY
<br />.
<br />.F
<br />r
<br />Tvvln [)R PNW TED
<br />r.
<br />- nn rl ~fbchmmh Aar
<br />(:uMMENTS AND EXPLANATION OF ANY VIOLATIONS lR•I.r• 1
<br />E'.~1"AL :`.:.h;. Li'.Il':: .ILL I', t. wAlYD, AYQ j=:TTLt:Ai'L SOLID` Lt1Y APPLfED t'ai. C=lUY4,21+Nk ~BECi: '1 ':t,.;
<br />I 1:,.`AnLe:_':i.IUt. L[.^.I' r,.iY ~tF .t;1'F:U F0:1 >IUYrl,llUiPi `:V f. 1.°.-S'.C i.><.I, Pi• J'tr, >t>p I.A.i, f.. -/. _ -`;i.Y
<br />~,.,,.: i. ,. I.I' ., ('1 I' tlcC T NI: •.rl: ,-g. aOq+`l,lY 1Y,•.• I1IIn14G Lr'.o. ~-~r: u~pn.i+.n, ~.i.~ ,~ 1
<br />
|