wino fDifjerext)
<br />.e :.r.RGY, Lh~.
<br />3'rJ1 ')ttftPY h'C+A±° b5
<br />FAC7UTY41t.'t3L.° .~ +-1:,`I;
<br />LOCATION
<br />iTI'~: .iBtrF U.i`~dY.kT
<br />NA77gNAL POl.L27lANT iN5CHARGE EUMMiA710N SYSTEM tN-OESJ
<br />DISCHARGE MONfTOAtNG REPORT IOhfR)
<br />^vrr ~N~~ nr
<br />PERMIT NUMBER OtSCHAfiGE Nt3MBEFi
<br />r MONtTOTRi-11G7PENtOD
<br />!YEAR MO t?AY ' + VEAR MO DAY
<br />FROM 1 . J I J I TO '71 U 1 31
<br />Form ApProwd.
<br />OMB Na 2Da0-DI
<br />I'% J:t
<br />(`su3R A;N}
<br />- Fj4AL
<br />.JA-1 L`lavavl'n
<br />ro R~'G f+SH
<br />~NOTE: Read tnstruations befom'L$mpleting ttti
<br /> 4UANTITY OR tOADiNG QUANTITY OR CONCENTRATION NO. fHEO(lENt
<br /> EX OF
<br />PARAMETER AVERAGE MAXIMUM UMTS AttNIMUM AVERAGE MAXIMUM UNITS '~v'~
<br />~"~. ~`9S1' SAMPLE :+`Sr`r ;: ::r~:r#;: #~C: yt -.`.:? { ;•}
<br />{ l V U .`' ~ , C } MEASUREMENT
<br />U.JS;.J t J U ~ F'EAMlT~-. -'4##1W qt. ##At•~#, '.::%`,: '* ~#711-' .~~?..:.`~. ~~i 45?;-.. ~ tft_•E~.
<br />c't'FL'1•.'NT ~'~~2iS YaLL't REOU(REMENF : - ~- ~ ~ t#_: ~'u ~;3$ ~ ~' '!~ 'T9 Y ris!`. K,
<br />~~~~'~ SAMPLE '.aa~: ~:= e:olt ;y ;t ;~#+k n~k:x ( L,
<br /> MEASUREMENT
<br />U J':.. J I .J I d'6RAtf~r. ~. -r.4A#F,#°~ r, . _r ` ^ x=' ~...• , .r'~..' , M EElL '
<br />
<br />..!C.'L' vrJ::~ vxLt'^
<br />~RE041tREMENT
<br />~ ;a z:~
<br />''~,.~;.
<br />,~.c
<br />~~L~ZkZ Pt
<br />a .r.
<br />..~~ ~
<br />Ott
<br />- +3
<br />S'titi.>, ~.UCAL SAMPLE •. ``s ~: {:.k i::'< .':a^.::: ( }4}
<br />.J 'i ~ . fi L L J MEASUREMENT
<br />V : , .i U I J U -~::= ~P~Ml3;' l`.~!aT~t96* .s _
<br />. • # '. ~, ~ .>` ~~ *d,..,.:. _. d .... - ~~' ,. {_.
<br />.r'f'E.J@::S ,;.J:i`% Y.9LJ AE0(JQEMEN7 .
<br />. ~-~ ~: .,: ..< ~ X M, +.,
<br />J 11, :.: rt L.L ~ SAMPLE ,. ,..::n ~: , <-":: .r s 4c;; V.•x X# .^,. r,,r:~ ~:-.; ( ' ')
<br /> MEASUREMENT
<br />a u t,'> , 3 ~ GI ~ :~ ~RMtT' -., ~' ~ ~" -° #~tMIt+IOk+II .. ik +k+s: a>'~~~ar>x°+a ~. q ~ '
<br />:. e::,JS.~r ;,a~» YAl.U R~oulpEt~!>Nr ~.,: ~ r~s~r pax '„ : ~
<br />(~... .e i'J?'AL SAMPLE ..; x • ~- r ..`•,:: '::; t t ~}
<br />{ A g i' ;; ~ MEASUREMENT
<br />t, 1:: +ti 2 J Et ~ -'x?ERMIj' - ':*#AEgrss.' '•atetksan~e .-.
<br />' ~ aQt~tEf#Ik ,~
<br />~ 3~5 7.a .`:J~
<br />~ ;
<br />!: r r' 1. J c '~ 'i' 1 r, J J 5 >: A L U r. REQUIREMENT ~ ^
<br />: r .;
<br />' Sj ~° ~ j _:
<br />,t ,
<br />Yi,J•e 1N C.J'i +,•UT.T .,~t. SAMPLE ( 9.!) tXa+Y'k## ###~~~~., .. .
<br />'! i :~ l! r ;..'?,i T ° `::+'f 7 L { ti ~ MEASUREMENT
<br />! J -: ~ I u t> ~ ~ -PERMt'~'>:, ~ ;7 ~~t~
<br />s!~ RCP~iI~~': ~ ". a ~ a>r a+sa~~ •;~ ~ ~::
<br />rE'i..t1F:':f ~nJ~~ YA:..i;. AEQl7lAEMEt~}T _
<br />3cfu+r, try; .
<br />~
<br />a "t •
<br />n,~ r
<br />r"~> e ''~~:'
<br />w.
<br />;:~x- - ~.
<br />^t t..)t%L 4:., 1-')".AL SAMPLE .:: 'x tr. '- ;t :td¢4'9 !S-:~h'F k'--~ 'F ."i.:`, •.:: .: { Z,.t}
<br />+:. [ U EI . i. MEASUREMENT
<br />1 7
<br />J7aJ L P~RMR . ~ : #C#+CrCQ! .~eM~¢:Al+illk~ ~
<br />
<br />.. .; :..
<br />„-- .. :AL'Ilpf~+A - ~ 4u`b'l1rRe~a ~_
<br />
<br />`
<br />
<br />~ 5 ., __ _..
<br />a
<br />JSS fAL4t
<br />I'
<br />i'F'i
<br />U AEQi1tREAtENT .._-. ..
<br />~-
<br />-'-.
<br />#`^~.' ___.,, _. .. _ ..__._ ,, - -
<br />!2
<br />ati:
<br />~
<br />~*
<br />~.c
<br />..-
<br />• 1
<br />NAME(fITlE PRINCIPAL EXECUTIVE OFFICER ICendy unaer penafry dbwthat mtsdxument end al atlacMnents were
<br />i
<br />i
<br />i
<br />iN
<br />i
<br />G
<br />d
<br />tl
<br />i
<br />d
<br />d TELEPHONE 9
<br />
<br />~'/~~-~
<br />~ t>~
<br />~'f t an a superv
<br />on
<br />n accor
<br />ance w
<br />a syAwn
<br />Bne
<br />prepared un
<br />w my
<br />~rect
<br />es
<br />s
<br />Iaa9sUrePW gLli4Aed pet90rf/197 tNapefl)'QA'hY &9d QY~iHB Etta 69.QlfrtlehM
<br />J
<br />t.
<br />~c v emSmrcted. 8aaed un my inyurty ar dw Person m pwsons wbp manage EM system,
<br />- Na inWrrtialiat
<br />pr tlwse Pereona OlmcUy respIX191Y,b Ip! gattmrmg the intotmel'Nxt
<br />
<br />~~
<br />' .
<br />true
<br />bne
<br />itt
<br />Cell of m
<br />knowled
<br />e a.W t~e7
<br />eccwm
<br />aM ccvn
<br />b
<br />d Is
<br />to U
<br />~' _
<br />L
<br />~'
<br />) t (
<br />~
<br />. ~ (J y
<br />g
<br />,
<br />,
<br />p
<br />.
<br />su
<br />m
<br />e
<br />,
<br />a
<br />a
<br />f
<br />I
<br />i
<br />' S(GNATUAE Of PA7NCIPAI FJ[ECUTIYE ,lG ~ ~.S Q t
<br />
<br />TYPED OflbRtNTED a+se
<br />nSermet
<br />on,
<br />t amaeare mat NrtXe ara siprtr6aaa Penm+ies br subm:itim
<br />E
<br />includ~n the ibdi or fuw ar+d' IscvvneN for AVOW' viotaf~ore. OFFfCER OA AUTHOARED AGENT
<br />NUMBER
<br />YEAR
<br />1
<br />
|