PERMITIEE NAME/ADORE55 pwdi/aWryNr'lermwl/olew.np
<br />NAME .,'1 .. ~ ~I _.. ~_ _'I'1: R yy
<br />ADDRESS`Ii `~". 1..'c.1 ~li'I ",i, „""°}' '
<br />1'+S IS R~'f r27
<br />FACam
<br />~. _ I ~ 1
<br />
<br />~ ,'.r
<br />NATIONAL POLLUTANT DISCHMOE FIJMINATION SYBTEM INPOfSI
<br />DISCHARGE MONITORING REPORT (O RJ
<br />r n 1 ', I
<br />PERMIT NUMBER asc BE NUNeEII
<br />MONITORING P '~
<br />YEAR MO DAY ~ YEA DAY
<br />FROM p 1 '. '~~ ~' T ;
<br />Y~.
<br />~~ ~ 1-r
<br />n _ :r~,~r
<br />xq!; S' II•'` A TO Fr~I J' I ^n-_,.
<br />NOTE: ~Ro~ruxaar bd 1 YP `RNtlnp thin loan.
<br />
<br />PARAMETER - ~ QUANTITY OR LOADING
<br />QUB~1Ly Of CDncentrati
<br />NO. frlEtiuiNCr
<br />of
<br />SAMPLE
<br /> EX ANAtyas TYPE
<br /> AVERAGE MAXIMUM UNIT NIMUM AVERAGE MAXIMUM UNITS
<br />-, .+,~..; - .. , ,.. ~ , SAMPLE
<br />MEASUR
<br />ME ~~ o s e a a ': r. ^~ :, ~..,.
<br />~ ~ ~ ~
<br />' ff
<br />3 tt0 ~ r l : `
<br />'~ I
<br />~
<br />'
<br />)
<br />~[
<br /> E
<br />NT J v : , i
<br />. /p
<br />1 ,:i r l -i 1 i1
<br />.:. .'~
<br />~ PERMIT ........
<br />.' x: r`X. T./ :F.Q'i .'.
<br />.: .. ~...
<br />?:./,C'.r~ ~'.Q
<br />'
<br />
<br />... - ...
<br />::'13'!5 •-~ ''
<br />..`
<br />/
<br />!i(
<br />'?.~ . ~' ..
<br />C:
<br />/
<br />~
<br />n'.
<br />'i
<br />F. ~ . ~ .: ,. , ,. , ,. .. REQUIREMENT: ~ .~::
<br />.." ~: "l:.~::.;. .
<br />~i~ . r .... ~
<br />~
<br />,
<br /> ' SAMPLE
<br />MEASUREMENT ~~ tu`. (e r;Q
<br />a°
<br />"
<br />:
<br />' t- .~-,
<br />~
<br />% ` ] 1
<br />(
<br />~ f
<br />~J ~
<br />r+~'
<br />"14l
<br /> ~ ~
<br />. .
<br />~ . ,
<br /> `
<br />I.i J:, '~ 1 ,i ~:~r:'nP.ERMIT.;.:::'~ ~: '.3 g:,: ,, :.
<br />..
<br />;:~tis~ p ~$
<br />~ ...,, .. ,, .,.:. ;~,y ...~.; :. ..
<br />
<br />i
<br />
<br />~
<br />~ ~'~<,~ 1,
<br />
<br />~ ~: I'.~r
<br />' h' L : I : ' ~; 4 ;t g S 'J :, ~ ~ , . REQI~IRE.MENT:: :~.;.:::.. ~. .. ~ . . ..
<br />~
<br />. <
<br />c..
<br />.
<br />: ..
<br />;, .. ' , , .: [ ~ i SAMPLE r: ; ~ :: x :~ ~ 4 G>:cf69 A~ ( '. ' )
<br /> MEASUREMENT ~ I ~J : ~
<br />~ /v/~ 1U1~ N~
<br />'!~?~ 1 'i ~'~:.'PERMIT.':.'. ,~:::,:6~:C+z4~~:~ft;:
<br />:; ::`:;~n.i.:...,.~~
<br />~
<br />~ :.r^:.r-:•r,~:.`:. :.a;:.ri`~:7:~ !!::::::
<br />'::?~ :~:~rH'.~ ...,.~~,/. ..T,p
<br />
<br />. .. r.
<br />- ' ' • °'•: L'?.. :REQUIREMENT :
<br />:~ ~.. ;:': !'~": ~>'~a~'":~:
<br />'..
<br />.:.'
<br />.~:~ ~ ~ '.~ .:~ ...).:
<br />
<br />... ?. 1<.... .
<br />:., ~.;: {i ;y: u.';
<br />
<br />... .. .:.:
<br />.~ ~.
<br />
<br />..
<br />~,
<br />
<br />k' .
<br />•. u~r'd~p: T:!. .
<br />
<br />., .. rn_
<br />Ir„
<br />r
<br />y
<br />SAMPLE
<br />MEASUREMENT
<br />`.':4ar14
<br />n~.r..;..
<br />
<br />~
<br />t,n)
<br />(
<br />
<br />~
<br />If
<br />3!
<br />
<br />~' ~r°~
<br />7
<br />.
<br />,
<br />.. ,., ~ .
<br />r :::..:.PERMIT:::. ,
<br />~. ;, ,,,k.
<br />,., .....
<br />
<br />~
<br />e.g
<br />.
<br />d
<br />
<br />~
<br />.
<br />~'..~'
<br />
<br />:'i"r'L Jt ,I .~~..; ;'.: Vn:-"r REQUIREMENT
<br />.:... .::. ~': ~' ': ..::. ~.~: ,,
<br />.. ..m ~,;,.: :.
<br />~.,..;. ~ .: ~.: ..
<br />
<br />~
<br />.....
<br />„ .....
<br />~.~ ..:.
<br />
<br />..
<br />.
<br />...:~~::..~~:
<br />NG/L
<br />
<br />
<br />
<br />
<br />... ...
<br />~~ ~
<br />P~l).t..~ ..
<br />Lr ~ r• ~ SAMPLE
<br />MEASUREMENT ~a '}:.-. :
<br />`'
<br />~ ( '[,) I
<br /> .
<br />~
<br />(~/ (~h I
<br />,; ,~ NJa
<br />
<br />~'`r ::ti , '' 0 ,...
<br />T::':>'PERMIT: ~::'.':
<br />~..':• :~Y: "~':~~
<br />^~"~ :h.'?f?:;3}a.•
<br />:~ .,.
<br />i
<br />
<br />
<br />
<br />< ,
<br />..'
<br />:... a._:.'
<br />
<br />~~
<br />.:.~
<br />
<br />.. ...
<br />..
<br />.:~f.E,/
<br />L.~,+
<br />- :REQUIREMENT :: ~':. ~ .: ......:
<br />..
<br />.:..::
<br />. ...
<br />.~
<br />,
<br />..
<br />.
<br />.~ ..::~~ ~
<br />:~
<br />...
<br />..~ ~'~, PiLEA::L SAMPLE
<br />MEASUREMENT rJ rttr r. ~.
<br />~
<br />`
<br />J ( ~•;)
<br />(~ I
<br />/ ,
<br />~' ' ~+6
<br /> ~
<br />. r 3 /
<br />
<br />) ~~~" i U U
<br />;':.-~::PERMIT::.~' ..., .; .:
<br />':. .,. ..!t '.~.'a`
<br />.
<br />: ~,~E
<br />:i~s'VfY'h F.i's'.~.,.
<br />
<br />..
<br />~ -. ...
<br />3,>. ;•::~'.~l ;?. "''..'
<br />'~L.'c:.f~ ~
<br />%~)~"~
<br />
<br />v .. ,~
<br />REQUIREMENT .,
<br />.: ~ ~
<br />~
<br />5 ..
<br />:'`.
<br />;at
<br />~
<br />~
<br />~~
<br />~
<br />:.:1
<br />' : w~
<br />~Y
<br />.. i
<br />i :
<br />. ...
<br />..:
<br />:: ,
<br />.::.
<br />~
<br />: ..
<br />::: ~•
<br />. .
<br />.
<br />~
<br />~~
<br />~
<br />~..
<br />~
<br />'
<br />^ SAMPLE
<br />MEASUREMENT ~. O+h3': .: :.
<br />' -,~
<br />~
<br />( ~
<br />~~
<br />r/3,
<br />r r ~
<br />/
<br />~ . ~.., ~ - , V':
<br />h
<br />' L U
<br /> .
<br />!'
<br />^ r'. ' , S V A r U'r REQUIREMENT~~ ~:~: ~• ~ ~ '.~::: g:,"y:;.~'.,; '.: ~' r:., - ¢ :,. ~.: ~ h . y. .. Y. : r
<br />.
<br />•K
<br />NAMERITLE PRINCIPAL EXECUTIVE OFFlCER 'aerngx erpm qerlx. rnxl N
<br />vrtv.rtd oxdxr n„ di,..non or wp h daryn.nr rrtl xl+m¢nrRnh wrrt
<br />rt3Nxn rx .Rxm.nn wun . rnhm aa
<br />n<d TELEPHONE DATE
<br />/ 1 {
<br />K r L I :(
<br />I r ~ ti (1 / I S t
<br />Ix mart rnxr qu.xnrd pnonnN prwxxrr, Purer xM rrYUxle me Inronnxuon
<br />wrenxn
<br />a
<br />e
<br />d
<br />m
<br />m
<br />r ,
<br />I .
<br />.
<br />.e
<br />on m[
<br />., e
<br />rn. Anon w P•n.n..no m.•q. n,r.>nnn.
<br />a
<br />~~
<br /> or mxer pram mr«n,mpo,dDk 3orplPennx ur mrxnn.non, mxlnrxnw.nen '%%:.~ ~~. 7 /
<br />T
<br />-~ r
<br />'
<br />) v:) ," r ~ ; /' , ~ ~~, ! r .
<br />
<br />~ .nxmnred h. ro lnx xel orm, lnx.r.drr.xd x.x.r, rrvr. xrrur+r.. n.d mmPlnx.
<br />rrm.w.nu.mm~xrtaxnfnnxr
<br />wnue rorrxxwxurw
<br />r.hr mmn
<br />n
<br />eIONATVRE OF FRINp-AL E%ECUTNE ' /• -
<br />~ /
<br />~~ /~ s-
<br />~
<br />I p
<br />x
<br />w.
<br />ow,
<br />n
<br />+
<br />l
<br />TYPED OR PRINTED w
<br />xd
<br />nx ln.p,.nnnu, ornwr.ne lmpnixnmrnr r«.no.lnv .la.u.b oFncER OR AUfNORIiED AGENT CODE NUMBER YEAR MO DAV
<br />a.vmmcm ~ nnv corr...,..., w..... ..... ....~r..,..n~ m.r..mo .rr .u.cnmmu n.,q
<br />
<br /> .l. ,•.
<br />
<br />EPA Form J320-1 ~. 3/99) Previous editions may be used. ~ ~ ~~ ~, / Uih~s3i; ~4+11~n~CQrm. PAGE toF
<br />
|