1'ERMIYTEE NAME/ADORE55 (/o~l.-/wvAgN~'L«rrr yp~l.wr/
<br />NAME ., .: ) ~. _
<br />ADDRESS ~ •. _
<br />AUK 45 a
<br />-:ICE CO 804)7
<br />FACKRI' .
<br />+Iy4
<br />LOFJI TfOf1_ ~ C~ 3U4E0
<br />., n
<br />YMn ApMtlvod
<br />NATIONN fq l1.TAMT dSGNARO( tLYNNATIOM 7YEf0.1 (rNPOf$( OR16 N4 =~'10'000d
<br />DISCHARGE MONITORMJA REPORT (DA+RI
<br />PERMIT NUMBER asaLAOt nw/FR t J ~ ~ • ~ -/
<br />- t' - f1i:aL JCX„+
<br />MONITORWG PERIOD ' % ' ' ~ ' • i T: ' . ..,.. ? n r r 1 1 i .'
<br />rYEAR _MO DAY YEAR MO pAV
<br />FROM-~~ TO ~ XR
<br />NATF• R. •A Yrrn ~rrirrv h.Ilri ITtw~l.rlnn rhi/ 1.vrn.
<br />PARAMETER QUANTITY Oii LOADING QUALITY OR CONCENTRATION NQ• ~tOUVr>ti SAMPLE
<br /> E% iy TYPE
<br /> ,wA
<br />~y
<br /> AVERAGE MAXIMVM UNITS MINIMUM AVERAGE MAXIMUM UNRS
<br />_ SAMPLE
<br />~
<br />( ~
<br />~
<br /> MEASUREMENT '~
<br />,., _ PERMIT Iio:•.^~ a/s.c;... ~•S Luc to+ ~•J '~C::/ `Si`i'
<br />_ REQUIREMENT , M ~ v
<br />i L '.., L . SAMPLE .. ~ , - ~
<br /> MEASUREMENT
<br />:~•: 1 U l- PERMIT /i_np~1 J•A ROC: . ~ kdIR40r•r is J:'t~V: -' . rhC-:~ '1?su
<br />•' 1' t. ,I i. ?i T , t;) -• _ / ~ REQUIREMENT .. --- . n
<br />_
<br />i .. ... .; .i.°w'A:: :. ---SAMPLE .. -. ~ ( .. ~1
<br /> MEASUREMENT
<br />.. ~> ~ U PERMIT =cor.:1 aeab^' eaCnO., •:nt r;-n :.,~ LaTI GFait
<br />'~ i +.~ a J:~ V .i L. ,, REOUIRFMEMT
<br />._L.
<br />r .
<br />t,.:~, i. :. i:JM1JJJI .,,. SAMPLE gi
<br />1/ .~~idA'YEEKT iii. r. .'. MEASUREMENT
<br />1 S) U
<br />, -
<br />' PERMIT
<br />REQUIREMENT E%iJa: <~. is-!~
<br />_ •_y-. r. •. u• 7O:n,.:: .~ ......
<br />i 4:. c ~ krI
<br />1 Ic ;', .,
<br />
<br />t Gr.J~~ 'I -
<br />. )r ~
<br />
<br />"' ~
<br />- I
<br />~. ti;> .i 1. }.nit - SAMPLE ~;y
<br /> MEASUREMENT
<br />i
<br />1 1 d PERMIT r4:•c •7 t:. ~~.. t: :' -,rsOr ~. tir :..: ~7-u.> ~(iC:,~ V:. .i i.
<br />-
<br />. ', a Yi`! ~ REQUIREMENT y • ` --- -- • r y,-' _--~
<br />-- SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br />
<br />REQUIREMENT 1
<br />- SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REOIREMENT
<br />
<br />NAMElTFTLE PRWCIPAL EXECUTIVE OFFICER o. n:r a
<br />~
<br />.
<br />r.
<br />i •i an......, .,n .v .n..ew .r,e ....
<br />TELEPHON
<br />E
<br />DATE
<br /> ...s
<br />.
<br />.. •
<br />.n~>•q. ..e•,.•~w rtmM~ iee •~.nn.awt,r _ _
<br /> b O.n I•M oaJl.wr petpu•1 pnpll. FYM, .w(. niN.le M IwAmw•(b. •r
<br />•
<br />:i1ChrLrr A. :!L""1:'D': r.mu,w /.a«...,.~,.,,.tw •...r.r r'ar .,w w..•.t. u..>„•.. / ~ :
<br />' i
<br />1'
<br />-
<br /> .. rr Y•r^~ •x..ri. n.pa1N" b po.nti m ,. o.v,•rlnn M rnrorrrb• ~ -
<br />. Lca i'resl~ent rMln.dk ba.ru•rr.LwYlrwl•lyr,,r., r...,l...d<~.,.- 97G, --~~..~333 03 OR 07
<br /> 1•w,•.r..wu,?rn rn fEr ~.ra•.w•rrf•r M. rr.ue,.
<br />frr. rnr.nrnew {NINATVRE OF /RAICJIAL FX[GVTM
<br />TYPED OR PRINTED
<br />...-_ f
<br />,
<br />u.I.oq,a.r•raon/r/r ^"'"'•"^^`~^'Ir'°°"'"e •,u"°•+ OFFICER OR AUTHCRIZEO AO[lEt
<br />.-~_._. A A n:;MgER
<br />COC~{_ YEAR MO DAY
<br />COMMENTS AND EXYLwNA 1 wN v nn r YIVLA r IVNO I/./IMM</ M QIICgTMlJ AM//
<br />~'r 1 `.i I
<br />004
<br />
|