KwMITTeE NwM[IADOw Efa /lnrludr
<br />fardiry N•mr/Luarbn ifdrffaent7
<br />NAME-Lt T? 'ZLCLLP:LI.~~L~ C~.LT)----_
<br />wonnm~c_.SJi°-SAL° __ __
<br />--- ° [,~;iT~~------~~9 G17L-
<br />/ILCI LI_ ~______________
<br />LOC wTIOM
<br />E TTN~ n~ C1C f_ CT^wc UC lw Doc^Tnc Mn•
<br />1
<br />" .
<br />Rw non wL rouvr ART oncRAwc[ [vrr.rN, non EYST[M lA'PDESI
<br />DISCHARGE MONITORING REPORT IO.NRI
<br />1 /b ~11.l9 l
<br />PERMIT RUMREw
<br />MONITORING PERIOD
<br />YLAw MO D.YV YC.Yw MO DAY
<br />PwoM r. J ro ,.
<br />.v
<br />na.)O nl.l it nGJb nn.)a + i r
<br />I ~ --....
<br />w j!'();; Form Approved
<br />(.iU?.3 'I'1) (t LOfiljTNa. 2040-0004
<br />F - Fi !!.i L Expires 9.30-91
<br />DISCF.,7CF TO CF±.?ST C~°_FR
<br />,NOTE Rend inrtruptrom Mnrl. n!Dletinp thit }orm.
<br /> (J Card OnIT) QUANTITY OR LOADING (I Card Only) pUALITY OR CONCEN iRAtION
<br />PARAM LTER (16-JJ) Uldll UiwJ) (IS-JJ) (J161) ~ NO. rR[oD[r.c+
<br />p (AMPLE
<br />LYPE
<br /> :
<br />A
<br /> AVERAGE MAa1MUM UNITE MINIMUM AVERAGE M/,xIMUM UNITS bIh71 Ib1AYr Ibp JUI
<br />{, II EAMPLE
<br />MEASUREMENT v, ~'^" +v r. r
<br />( ) 1
<br />~• { D
<br />VV r n
<br />'Y /~
<br />grZD
<br />( In)
<br />fl~ n
<br />6M1~
<br />/~1-~
<br />CJriL:,) 1 { 7 PERMIT r#v#v# #~=?ii:# v• •
<br />6 ~ v
<br />,-##A ~ Q•
<br />J
<br />~
<br />~ rCE
<br />ZLT CIAH
<br />F:F''LUP.rT :7^S3 PAf.I R EOUIREM CNT ..
<br />F p. ~ ,x -..~
<br />T,.:I ~
<br />;]'JLI D.i, :JTPL EAMPLE rr-••, ^Y•^r (
<br />) ~.. •. ( 1D) /
<br />
<br />
<br />°USPE1Ch'"
<br />MEAEUREMENT p
<br />
<br />~
<br />
<br />~ r 0
<br />J
<br />30 G^R.4S
<br />
<br />,!
<br />D7J3J 1 N 'PERMIT #A:vt:,{.` #AV#ri 'r:Yi =:'~: '35 ~ ~ ~
<br />
<br />" 7v" .'. ~ !7CE/ S.LR
<br />
<br />FFFIUF,."r (;D~cS VL1,U REDUIREM ENT
<br />~
<br />~
<br />!
<br />~.~ A
<br />.IY
<br />r•r
<br />r .r+•
<br />:LIL A!'D ;F:°4SF .AMPLE
<br />M ENT
<br />ME
<br />R -~..~ .n... (
<br />) ..-n-rr r.,r. ( j•9)
<br />
<br />/,f U
<br />E O 6 /~B
<br />I)5 `6 1 C' ~ s'JERMIT #t#Y ,## ~
<br />,~ 1B p4fIR RAP
<br />
<br />F.FFL'J°!:T ;P:155 DP L'1 REOUIR[M ENT
<br />- -
<br />~
<br />
<br />. . ,
<br />,r~
<br />L; ,•
<br />
<br />•
<br />„~T
<br />I2Jti, Y~' rtL EAMPLE ,.r,-,,, ,r,..Y. )
<br />( Y,-,rte. (
<br />13)
<br />
<br />(Jj Fes)
<br />MEASUREMENT
<br />Orl7Z
<br />p.OZ
<br />~
<br />)/jO /~drJ
<br />l%~".O
<br />L'1:It5 1 C ~ P[RM IT
<br />RE
<br />R
<br />T #r#,'~'~i V:.., a:,s..;.s
<br />'. rr .. w..
<br />~~`
<br />~"
<br />~"'~n'
<br />3•S' ~
<br />:'"
<br />7•C -
<br />9C L/
<br />RAU
<br />G
<br />-v r
<br />D' OUI
<br />CMEN S ,
<br />; ~
<br />,4
<br />F U
<br />R 1 TT Y ^ M rT
<br />,
<br />I
<br />j E ~ (
<br />L3) "~~vv r,v.. , •. (
<br />)
<br />
<br />TR:2Il
<br />TFi'TCFA
<br />i
<br />PLA 7.
<br />ME 6UREM
<br />FNT
<br />0 OZg
<br />1
<br />O.29
<br />•
<br />I
<br />//7 .I
<br />S7A/V
<br />SJ05J 1 0 C PERMIT BEPORT:' OPTIORAL. `#~#~#~ ::a:c ~~.
<br />~ r.•n pr.:, ?,RLY SSTAU
<br />
<br />LrC{.UDrt rP^.SD Ifa 1( R[OUIREM ENT
<br />.-y y,~ ;~~
<br />.. ..
<br />
<br />.~
<br />SOLID:,, ~QT.1L SAMPLL ,-;##, ,r...r. ( ) r,.,.r,. 19)
<br />(
<br />
<br />D LSSOLVcI
<br />MEAEUREMENT JODb ~00~ y/40 L-~4~.$
<br />7'7245 1 (' ^ I[RM1T . '4`=?#4rs . ~x.AY;a:;x:=; ~. r.:?##Y:? ' gPTInR9L REPORT TRL! RAR
<br />
<br />~FFLUe~T ~De~.; at~nT REOUIREM ENT
<br />a:
<br />b .
<br />s ~
<br />ULL A•ID ;I:FA Si'. SAMPLE
<br />MEASURfM ENT +„ •„ O ( ()[{) o.i,• :~--~:#,•~ .... .: (
<br />!
<br />l
<br />YI~CAL L
<br />~ V?S~
<br />
<br />tr{'7 F.U 1 n ~
<br />PERMIT
<br />##v r#~ If
<br />`r ~
<br />Lys-1
<br />.#v ih
<br />'?'•~#~`
<br />,n#r,:v I
<br />.
<br />
<br />'
<br />DF:SLY
<br />ZSUAL
<br />L a'DLU.n,l -4.,cq V31. 11. R[OUIREM CNT ., 'M U _- .. ~~
<br />..
<br />NAME/TITLE PRINCIPAL LIECUTIVE OFFICER ~ C[Rrlrv UNO[R rSrvwLrY Or L/.w M.r r Av[ r[wsON.LV fu•nNED
<br />ANO .M rAMiUwR wriN M[ meOwM,nON SVBrn rt[O rr[RUr+ wwp 6•SED TELEPN ONE O A T E
<br />// ~~ r \Q ^ Y
<br />rj(r((~ h/ 1 ON w iMNRV Or i•q•[ mpviWAS rMrrEpAt[N w[EPpNE~BL[ cOR
<br />OBUiNrnG inf iNr(AMwnO.V i R[Lr[v[ .NL BuBUrrt[D wcORU,nON ~ /
<br />~
<br />/] /e
<br />'
<br /> i5 rwu[ ,000R,r[ .ND CWR[T[ r .M pww[ M1..r M[R[ .R[ SSG •
<br />-_
<br />l /V-CM
<br /> r^unr •[N•Ln[s row sDfwrmiNC rus[ wroR..,roN mcwo-r.c ~
<br />hJ (Jlf~f P((M l'~"
<br />M[ POSSB~ur+ Or rm[ .NO n•M50NM[N+ 5(C r! VSC 1 rWi mO
<br />]]u5C 1 rP9 rP.n.ho. r.M.. rbr rare .r ur• rnNWr /.n..
<br />llnrur
<br />e
<br />aIGN ATV E OF PRINCIPAL Ef ECUTryE
<br />IQD ~I'/'I _
<br />/7~I'/ZS3 ~]
<br />/~
<br />/D q ?
<br />23
<br />TYPED OR PRIMT[D .
<br />.P
<br />s.d..,.r..rnwr rrnP^••^^r•rrr •./F.lu..n•+..nrl.. cnd :.r.r., piFIC CR OR AUTMORIS[O AGFNT AREA NUMBER YEAR MO OAY
<br />OIL fe GF-'AS°_--SEE FOOT YOT° F/, PAGE 3. QRTRLT SA!1PLI NG IN3T RUCTIONS--53F. FCOTNOT? D/. I
<br />EPA Form 3320.1(Rav. 9-08(PrsvlOUa Ediliona may DR USwd. IwEPLwcea e•A POwM T-•e wNrcR MAY woT fe DaED.I I Pwce oP
<br />• ^, •)1 ni/'?1'ri15-1.'.'ll 1
<br />
<br />
|