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~ <br />PERMITTEE NAME/ADDRESS nctude Faciti Namd[4canon i Di erenr - <br />i~ ,~ <br />(~ rY l ff ) NATIONALPOLLIfTANTDISCHMGGE E41MIr,IgTION SYSTEM (NPDES) ~ 6Orm appfOyed. <br />4 <br />+ <br />~ 'OMB N0.2040.000 <br />NAME TA;PPdR HINTNG, IRC. DISCHARGE I{~6NITOAING REPORT (OMR) HI NOA <br />ADDRESSTR;PpE4 HIRE r (SUBA NR) <br />P•P._BOK 15/ PERMIT NUMBER olscHARGENUMBEa F - FINAL #IOFAT <br />` CO F111i 25 ~ MONITORING PERIOD ACUTE ii F.T. TEST TNG T09 Q19A ~ ;' <br />FACILITY yR~y <br />_ <br />LOCATION ~ ~ ~- ~ - YEAq MO DAY . ~ YEAR MO DAY ~ ~- <br />' <br />FROM -. TO 0 1 1 ~aa NO DISCNlR~E ~~~ ' <br />~ <br />m~letiPg Skis loan. <br />A r i t• r M •. C• O R D O N P S T E H 5, P R E S/ G E N f' ,^i 3 NOTE: Read Instructions belore <br /> ' ~ ~ ~ Q1IANTITY OR LOADING ~ ~ QUANTITY OR CONCENTRATION ~ .- .NO. FREOUENC SAMPLE <br /> PARAMETER EX: :pF TYP.Q <br /> .. AVERAGE MAXIMUM' •, UNITS MMIMUM AVEf1AGE ~ MAXIMUM ,UNITS ~ ANALYSES <br /> ~ <br /> LCS S~T[~jtE SHR.AC .~SAI6IPLE~ ?R •## .a4at~a ~ ~a#a##.- a#Ik[7tQt# ~.2~3~...~.. <br /> C,ERIDD~P~INIA MEASUR~MENi '~ <br />~ ,. ' <br /> IAM3tl ~ .'~0 U sa# ~~ :i <br /> 'r.FFL-SNx G_iROSS YALU. +P#+'c.# ~' ~ <br /> L.:SU ST T E 96H:R ..l C. <br />4 SAMP-~ as#4~a# aaa>MO# <br />` ogre#. <br />~ I'YlD+IAd.. <br />1 <br />, <br />1 ~ r , <br /> '. <br />PdMEPH1~L$5 <br />~ MEAS~p~ E i = <. ' rr. <br />r <br />r a.. + <br /> <br /> EFFLUENY, OAf]SS~fAL `~~ ~ #a ~ ~' ;"~' ~ <br />x- t `` <br /> <br />~ <br />~ MPLE t~'. <br />L - .. <br /> <br />i ~ ~ <br /> <br />~ M gEMENT . <br /> . , ,~',. st ~t ° ~~ f ~ ~~.~ <br /> SAMPLE <br /> ' ~ MEASUREMENT '-~ <br />.~, <br /> ~ SRw. //w y 'y` cm ~~ ~ I i~y <br />' _ <br />If <br />ve '..W ..y <br />. <br />i '; ~ SAIdPLE, <br /> <br />t <br />I <br />~ ~ <br />MEASUREMENT ` <br /> <br />N <br />! <br />•" <br />- <br />- <br /> ' <br />f 1 <br />, \)` <br />V 1 ~ <br />t <br />~ <br />. Wr <br /> <br />`. _ <br /> •~ <br /> - ~'~ SAMPLE <br />~~ ~~~~ <br />r - MEASUREMENT <br /> <br /> SAMPLE ~ ~ - - <br /> ". •. MEASUREMENT ~ ~ ~ ., _r <br /> - ~ <br /> :. <br />3~_ <br /> <br />' <br /> NAME/TITLEPRINCIPALEXECOTNEO FFICER ICerery und~rpdnalryoflaw~hat t~isdocumentandallatta chmen(aware <br />- ' - NE" <br />TELEPH '_' _DA IE <br />• <br /> ~~ ~ ~~:---- - prepare0 urMer my direction or supervision in accordance with a s slam desinne~ _ _ - -- - -- - <br />1o-assorofhAtgnafBedriersbt>ri.tyrope7ly'pal~en~aluate thaintormation - /J~ <br />, <br />~ ~ ,t <br /> <br />W~• GOT~4•P#~7RtI,.~ .. ~'~8 <br />t4r <br />4O1- <br />3ubmiryed.,¢ased.on iffylnquiry.otthe~Qarsonor.Penons wlro menagethasystem,' ~Q.,.~ 1 <br />- <br />, <br />'~ VI 1 <br /> YL69 t{~~~1~ ]~{ !I' <br />~lfl ~$ aY those persons Grecpy respons%le lpr gathering the fntormAGon, the lrAortpauop - { ~, <br />submibed is,to the b•stol mykrwwleCge'8nd heligl, Vue, accurate, entl complete. SIGNATURE OF PHINCIPAI. EXECUTIVE <br />t <br /> <br />D ORPRINTE . 1 am aW <br />dra thatfi6[e are sigryfkagt pglalees for;db({Yainplalse iNonnatiorl, - OFFICER OR AVTHORI2ED AGENT <br />includle the osslbi btfne anA lm is men( r ova violations. ~ <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND' PIJtNAT40N:OF lji3`! VIOLATIONS (Reference elf attachments hare) :, ~ . '~ <br />:;EE I.A42,~ Op ~~9, POR DEtAILS•;DF TEST YROCEpURE. RF,PORT LC 50 - STATISTIC;L POINt SS'fIdATe-ft(tICR_ IS <br />LETHAL !'0 50.x, DY "TEST DRGANISlIS, AND .ATTACH ACUTE TOXICITY TEST REPORT FORIt~ TO -i7R. COitICS DT !LL' <br />. ~---.,.., nr r o ote„,,.~,~e ~t.,..,~..,~„tie,~~o ~ S n rF n <br />