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-~•~~ V , , <br />- - -.. _-„YT 4d ~.: ... <br />+ 6 ELIMINATION SYSTEM <br />G REPORT Form Appr~ <br />OMB NO. !!e-R0073 <br />ti. <br />t. <br />INSTRUCTIONS <br />J 1. Provide dales (or period covered by this report in spaces marked "REPORTING PERIOD". <br />2. Enter reported minimum, average end maximum values under "QUANT1TY" and"CONCENTRATION" <br />in the units sp ectfied for each parameter as epprop ri ate. Do not enter values [n boxes tonlaining <br />asten sk s, "AVERAGE" is average computed over actual time discharge is operating "MAXfIrIUM" <br />end "MINIMUM" are extreme values observed during the rROrting period <br />3. Speci (y the number of analyzed samples that exceed the maximum (end/or minimum es eppropria te) <br />pennrl conditions in the columns labeled "No. E%." I( none, enter "O". <br />4. Sp act (y frequency of analysis for each Daram et er as No. enely sea/No. day e. (e. g., "3i 7" is equi va- <br />lrnl ro 3 anafys es pcrlumred every 7 days.) 1f rnntinuaus enter "CONT." <br />5. Sp ccify sample type ("grab" or "_ hr. compo.:i(e") as appltcebl e. If frequency was conlinuou s, <br />enter KA". <br />6. Appropriate si gn store Is rrgw red on bottom of this (o nn. <br />' 7. Rrmove carbon and retain spv (or your records. <br />>3. Fold along dotted lines, staple and mail Original to office specified in pennri. <br />_ mJ-eer leu-rci <br />(J aerd unlyr CONCENTRATION FREOUENCV <br />i6A(l"?N-G! __ _ '1_ ia~~5'_. .5J-0n IEI-631 GF SAMPLE <br />cO~ ~ MINIMUM I AVERAGE MA%IMUM ~-UNITS E% ANA LVSIS TYPE I <br />_II ]^ i-~- -~-- - ~-- <br />R p p R I p A p p I- p-p-- 4 R <br />-r ..._ 1 CU.M/D <br />R p # p' p p p 6 p p p R <br />R p R R I p p p p~ p R # p <br />-~I` -- ~ -- -- - - su <br />I p. ~O R R p p p p p p R p <br />R p p R. ~' O <br />-- - ~- - - --- ~ MG/~ <br />p p p w , 30 45 ~. <br />I , <br />-~ - - 1 <br />I <br />- ~- - - - <br />I ' <br />i <br />,_ -; - <br />-- I-- - I - <br />I <br />r._ <br />-; ~ 1 <br />cerh h' (h,~t ! L,r :7rnr e:lt lh. r Linn .r^ n r.r rr. •d in this <br />report :md that n d.. h~ .r (na knnra •r .~nrl b. Irr! vrh mlor- <br />malion i_a rm^. a u:Pl. .l, ~. and m r ural~ <br />I/90 ~ NA <br />I/90 I GR <br />1/90 I GR <br />-+-- J <br />I- ---- ~ ~ <br />- ~--- <br />~--r -- - ~; - -- -~ <br />I <br />- ~ --- <br />- - .-- i------- <br />I <br />-~ - -- <br />sIG ATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR 4U THORI2 E0 AGENT <br />W <br />gllp~ <br />~y~>, <br />Yuu~ <br />;uuu - <br />P4GE OF <br />I 1 <br /> <br /> <br />