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(/nc(ude -wcl urr LOC/VTION_ r. L.l nLL. 4. PZL--- ,I. C~L+ Lt -- M ATION..L FOLLVTANT OISCNRwGF FLIM INATION SYSTCM /NPDESI DISCHARGE MONITORING REPOR71DMR/ 1 16 1719 ... iG7.1 `4 ..IJl PERMIT NUMBER puc HwwcF nuM.cw MONITORING PERIOD YEAR MO DAY YEAR MO DAY FROM i } _ . 4, TO J V .. L U nn.rn nzva nA_x. A.Tz n -•'' •" ` Form Approved. (3 U ? ~.~ ti d) OMB~No.12040-0004. I• - F I N A L Approval expires 6-30-91. ::chret, rCm~ .. LJ _.}iL3L ~. `. NOTFe Rwr1 inatmNinna IMFn.w ~mm~LTine the form. (J Card Only) QUANTITY OR LOADING (1 Card Only) QUALITY OR CONCENTRATION Fp EOU [rvCv PARAMETER (Ib-JJ) (Jlfi/) (JBaJ) (Ibf3) (Ji67) NO. of 9AMPLE TYPE (32-37) E% wNwL rsls AVERAGE MA%IM UM UNITE MINIMUM AVERAGE MA%IMUM UNITfi 676A (bVfibl (69-]B) .S .. Ji. ~Z1Vi'[Y 6AMPLE y1"r`ii=.- ;-J;: 1,=Ti .l ( ) +. rr.. ~ ~ ~ ~ ) ( - 1 LI/ MEAfiUREM EHT L` ~ ~ Y l i ~ O O 2 D r ~fLtj I _ Y 1 L. L, 6 r'a. . °a a PERMIT ~.F'# F:~.( w y. r $J'^."S YFdY!Y riq' Si Yi Y' ^ CIT'^'P".SF.E.49>~n .. . 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" 6 ~`< °>r~ ~ ~ ' s „ ~ e . , I a ae, e <s ° .. _ °~1: oxm a ¢° R ~a.fi.. o-..m ~ : ~ ~/L w A d's a.a wa NAME/TITLE PRINCIPAL E%EG UTIVE OFFICER I CEpTIFr uNDEp PEnALrv of uw THAT I MAVE PEpsONwur ExwuINED 1H0 AM F/.MIL4R WITH THE INFORMATION SUBMITTCO HEREIN 11ND MS ,-~ /) / TELEPHONE D A T E _ ' ED ON MY IIpUIRY OF THOSE INDIVIDUALS IMMCDIATEIV RESPONSIBLE Fpi OBTAINING THE MFORMATON. I BELICVC THE SUBMIT.ED MFORMATION _ // ~~ / / /r / /( / ~~ ~ ~[~ ~( [ 11 ~ IS TRUE ACCURATE AND CONFECT[ I AM AWAp[ THAT THERE ARE SIG }A / / l~ ^/~ ~/ / ,:O MFICANT PENALTIES FOR SUB.IITTING IALSE MFORMATION MCLVdNG J !!~/ !~ -i7 li r[rl .n'I[IIIa i nlJ~Qr THE VOSSIBILITY OF FlNE AND IMPg150NMENT $CC IB USC 5 IOOr AND rlr ~.'17 E G-771 ! ~ ~ ~ .~ 33 use ; IJl9 rPm.lur. u.drr rArH• u.mrn ~ v ,.rldr /mr.. e lln Rn SIGNATURE OF PRINCIPAL E%ECUTIVE i~, I ~ TYPED Ofl PRINTED y . a•d.nmv.mrwr m.pn...rm,n.r../Mrv..nfim.mrM1. and3 v.r., OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY .E _..3 V:I, ai. ...__ ~.1 ~ ~ _ i.; r~'SL _. ..~L> _ 1..') r: ~- _. L. _~ ._ .., -Y.'a ..'-il ~~ _. __l:l :: 4't .. _. _.._-.l Ls,• ;i .. ~' i. _.1F r.. ~ F 'Ln ~:'.. .. .t I':I J.-~L. •PL L'1 .:.. i:. _A. - .,..n; .---~_- ., ... •. ./ir. Fi• t'_ _• EPA FOEm 3320.1(REEV. PBB)P)7Ylou9 editions may t>9 used. IREFLwces epw FORM r-AO wNICN MwY nor fic useD.l Fwce of