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(1nr1RJr / ~t"3 -1----- OCATION_____ '~[ _`__ RwncnwL rouorA Nr mscxwweE ulMlxwnoN s•sreM tNPDESI DISCHARGE MONITORING REPORT !DIlRI . 216 /Alfl G)C956G13 ~ 00~ /ERM17 NUM B[R DIECRAwcE NuMPkw MONITORING PERIOD YEwR MO OAY YEwR MO DAY FROM I TO J 1 /Z0111 l11~731 rN-151 l36- 71 118~I91 ! Q 11 ?~ I (: G i+ ~, Form Approved (SU9H t!J) YImMBF'ND, 2040.0004 f' - F7 N A I. Espires 9-30-81 PIT C3 G~CHHG TO 1;3ASSY C3:'', NOTE: Reed inttyuetiDns before completing this form. (3 CRTA Only) OU ANTITY OR LOADING (I Ca.d Only) OU ALITY OR CONCENTRATION EREDUENCr SAMPLE -ARAM[T[R (eb3J) (SIb/1 (J8A3) (1633) (1161) NO. 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Y „ v ° Sa p . i . 4Y ~ .O ° NAMf /TITLE PRINCIML E%[C UTIY[ OFFICER UNO[w PENALTY OF Lww THAT I HAVF PEwFOMALLY [kAMmED I C[RT6Y TELEPHONE D A T E ' j AND AM FAYILIIR WITH TMC INECMMATION SUEMrTTEO HCRCIM wN0 Hw5C0 , [ • /// ]]] -- - J, ,[1'' / fl ~LN / \ ~(~•'T `)~ ON MY INOl11RY Of THOSE INPVIDUALS IMMC(MAIELY wFSPpI51BLE FOR_ OBTAINING THE INFORMATIO.Y I BELIEVE THC SUBMITTED INEORM4TON ' /// / / ,/ // r~, // // "n . %/ n /' ' , , ' / 1 c /~ ~/ ~ _ 5 TgVE wCCURGTC AND COMPLETC I wM AWwRE THAT TNERF wP[ SH3 ~ l y TI E H R I N C A M l/ Yl / LY/1/ G L/( ( /C '( _C /~/ A <~ / 1 I I ~ ~ /~'/~L / ~ ~ i P65510,LrtY OF f C ANOaMPR60NMENT I I i[ SFC U SC DO UpND O /<.~ I} [ { C~ ~ ~~/ ~~ % / v u5c \ I>19 rP.mhr. end.. IhT.. nrvrn wav wNud^ p... u h. pnr.n ONATURE OF FRtNCIPAL E%ECUTIYE f''N!/ / I ~'~ TYPED OR PRINTED y md.n nennrwl lmpmurmr.ru :d n.~m..n6m•.nfh, and.i .ca.a OFFICER Op AUTHORIZED AGENT AR A NUMBER YEAR ---- MO IIAY COMMENT AND E%PLANATION OF ANY VIOLATIONS IRdornrr Rll Rnu<'hmrnb were) :l"rLGF.k'..k' SOLT(15 LII'ti'P dPPLI~S ONLY IY ~= lit-YEtr 24-IIR PF~CIP k'YL'NT IS rLAIN;a'. i? i:LAI'! A?i~HOY+: .. J~!..'1., T5; f; IRON LiPTTS PILL 90T i3 P. APPLf;'U TU Il$PUBTP•.U t1EA5UHEhE4T5:-SEE I.13.1A, :': )[ AND I.Ei.li), .. . c?A Fnrrn,:120.11RBV.9~88) IBHOUSHdir/ori9Jhybe sBd. ~ ~ IR[P4wCEeEPAFORMT•eOMNICNYAYMOre[Ue[D,) ~ PAGE OF