PERMfTTEE NAAIFJADURETi$O... FrLLry,v~/frrlw yDdi..r)
<br />NAAE
<br />AOORESS ~ .. : .
<br />':.PE:k nT BV51b
<br />FAaLm
<br />:.AVIfl •'i. NT1. f. Y.R_ RIIC TiI PfC MC--
<br />Fomr Applded
<br />MA11pNµ .OILIRAHT OIEGHMOE RrMMATp11Yf[Td (NPDFSI OM7 rb ION}000<
<br />OfBCHARQE MONRORWQ REPORT lDMR1
<br />^i
<br />PERMIT NUMBER as[uyf0( up11yP - ~ }' :.; \: _ _, • .,
<br />MONITORWGPERtOD •ERGROU#D MIN>; TO 'Si_" '.'P.
<br />YE R MO DAY YEAq Mb DAY
<br />fROM TO
<br />NOTL R..A ....rm n:r... L.. f.......,... . ,ice.- :IJ• form
<br />
<br />PARAMETER OUANTTTY OR LOADING 4UAUTY OR CONCENTRATION NO, r~totnNCr SAMPLE
<br /> or
<br />
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MA%IMUM
<br />UNITS EX rWKyyf TYPE
<br /> 5 AMPLE
<br />r
<br />~
<br />/
<br />-
<br /> MEASUREMENT
<br />- 'I r ~
<br />_ Nr '= ~ '
<br />i ~
<br />.~-
<br />JJ=JU J PERMIT un, fJ __..r_ - 6.S :~:pr2d .I•'/ IEc.,',LT IMiiTI
<br />' REQUIREME
<br />T
<br />C.t f
<br />;U t1ij vH:J~} Y=.: N tlIY1:tU!! 11AI I>lD it
<br />:i!yi ArJ• TO1'dL SAMPLE ,. -..- ':
<br />~
<br />" ---
<br />)
<br />5
<br />5.1:iPENE+ED MEASUREMENT ~,~ .¢Z ;
<br />: :;
<br />Y
<br />J!!'>SJ 1 J PERMIT s~4^3i ztc'. ~.o 00 PO Si 0 ~+
<br />~ ;^'+
<br />1
<br /> . : . 1
<br />- if: it t. ot3 ~1: ~
<br />~ REQUIREMENT
<br />w ': Ur rt'7 :~ DAi~Y !7. -/t. •,. '1 i.
<br />i
<br />.:5~ iJTAL SAMPLE .,. .. -'- _ _ -__
<br />(A$ vc~ MEASUREMENT `I :'~ f„}, J zG ~~:
<br />-~-) 1. 0 PERMIT ^~`"~c00 .,q?OOC ~ tF4P10e 3.~ . __._. _
<br />;:: +1T ;R~.. REQUIREMENT 3QDx A~ , DAI L:' ~X i,
<br />. ~; r) u~ iCA:iG SAMPLE - - ,. ..; ,. ~cn. __. ~ ~ __ .._ ..
<br /> MEASUREMENT l,;~r ~ ~ J•
<br />1 0 0 PERMIT 7PL1s~t 74 ^GRJ OOfFJP-^. u060: U 1 J ,\i':: ~
<br />
<br />.. ''9T_ ~"Ram, :a5 _.
<br />I
<br />REQUIREMENT
<br />_
<br />iNST 'Ai
<br />'"
<br />!~_: !i' ....
<br />IN COHDU:
<br />' s~r.76Le ;; - -
<br />*EEA2R£1tT ! .. MEASUREMENT /
<br />iJ. C')y~i Cl. ~ ~'~ ~ ~^
<br />- Z D :I
<br />,~.' PERMIT kLI•-7 Rip^riY a0osoe. ,; v4 a-q •, .~~~ ....
<br />!ia GkO=: : Yn:.'% REQUIREMENT 31)DA lY: J!.?LY 1[ _
<br />. ..)~. T7TAL SAMPLE ..
<br />._. ;LY EJ
<br />
<br />~ MEASUREMENT 1~_T./J 1SC~S li
<br />;/, =
<br />/ i 7i1._
<br />
<br />~
<br />._ ~
<br />) 1 O PERMIT ~ d 7 ]O Pt c .oa = Ai:70kf 8a Ck. -: x{,~T ;.
<br />s
<br />.:'r i.JENT GH:i :iS Y'~. :. ~, . REQUIREMENT
<br />-
<br />-- ,?HiR f.4'• DAI LX KY -.
<br />
<br />.1 i A v S
<br />-„ x, L
<br />SAMPLE
<br />MEASUREMENT _
<br />~. -
<br />
<br />l-.
<br />-. -
<br />:. -
<br />- .
<br />
<br />~~
<br />t ,
<br />
<br />:•.~:
<br />
<br />
<br />%
<br />
<br />-- .
<br />P£RMIT
<br />n06~ aE OYi7 zi •5 O+ a [+O E
<br />5
<br />' ,
<br />REQUIREMENT i 5 S T S A Y
<br />NAMERITLE PRWCLPAL EXECUTIVE OFFN~it rar.n.. rr.n..,T wur w. nrnr meu.rr..n...w -.r.
<br />TELEPHONE
<br />.~
<br />•`•u.w
<br />s
<br />r
<br />CA TE
<br />..,.ar..
<br />w
<br />>..,.•-.
<br />Ln ln.<,ni..,.'.uL ..Tn... A,Lra„u ~
<br />r
<br />_ _ IeLYLn~.rr.rdlM,.rLMwrf NLPA1 lNTn rs'..LLVLr.WMbtwLWn ~ /
<br />' ~7".
<br />' .
<br />~Mnnf i~J r.. ~. •^Lw:rr N W
<br />r
<br />. ~ ~ ~
<br />Lnm
<br />A
<br />Q
<br />1
<br />~
<br />.
<br />. ~ .
<br />tr
<br />a.
<br />o mw.r
<br />L .rL
<br />Y
<br />wR
<br />.~ -
<br />t
<br />_•
<br />/
<br />R
<br />~
<br />..
<br />- ~\i
<br />s n.. rL.... a.,....
<br />rgen.l W f~ tLUM W In-rwL1,.w. 1k INe.wULn
<br />Ml
<br />~
<br />N br
<br />!
<br />`. ~: ' ~
<br />4
<br />
<br />: ' Z
<br />'
<br />le
<br />a
<br />an Lm.
<br />, ` ` S ~ C - v
<br />4 M i
<br />p M b.ref. Irv. LRUMC rL! aw./IIY- r., t1i
<br />•:
<br />, .
<br />,
<br />Ir~f.MM1w rMn... gNnrnr p+LUrL brnbnlrM[ttl>. bixr..s... 110NA7URE OF RtM[]PAI EXECtli1VE -
<br />"
<br />TYPED OR PRWTED 1idi~nt it rLSare.Tr+~.r.ne e.AILLL.n.,,r wLro.eq .ra.1L~ OFFICEf1011 A17TNOR{ZEO AOENT A TNMlER YEAR MO DAY
<br />VVrm..Lr. r.a ~nV lnr v.rr~..vr. r ~... ~.~.~.. v..r r.r~
<br />aPA For~• 3_.. 4e. T?9` P~.v.o•rn eC ",r• m„, b.' .. •.
<br />
<br />
|