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-` Rer tilTTee NA r1p oREee pnctude <br />Family Nrmt/l~ .'difftrtnr/ <br />NwM!__C: :..n:~' 1`_~l ill= i)`"F 'l~y_-_____ <br />woowls! '. /; 1. may,; ~!''~`.----------- <br />-__J J. ... 11.1 1~~Itw~~Z-- -_ <br />------------ - -- ------ <br />-AUUrr----------- -- ---- <br />LOCATION __ ____ __ <br />Nwrlon wL PoLLUrA tcnwwo[ [LI MIw wTlon srsrEM INPDEJ/ <br />DISCHAp~- .dON1TORING REPORT lOMRI <br />116 17-l9 <br />"'lli :1 "~~J 1 <br />rERMIT NUM RlR olsc.lAwcr xuNrrw <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM J J 11. . i TO a •` ~. <br />/10~1/l 111-13/ (1f S/ (16 / !1 191 /30 11 <br />~ `!. I <br />;•, 1;;;1!i Form Approved , <br />( f, C) t ii F w 1 "! 041 ~ 1No. 2040.0004 <br />F' - ! t: ~. 1. EXplras 9-30-91 <br />w 4ni::iC 11 `1 :: .r :i t.1 'i ~i y'AY ~:I i, ._., f' ~; <br />.NOTE: Reed inftructions before rnmplating this form. <br /> (J Card Only) QUANTITY OR LOADING (1 Card Only) QUALITY OR CONCENTRATION FwEOU ENCr <br />6AMPi <br />PARAMlTER (db-33) (7161) (J8-IJ) (Ib.fJ) (31b1) NO. <br />EI( of TYPI <br />(31-J7) <br />' AVERAOE MAXIMUM UNITB MINIMUM AVERAGE MAXIMUM UNITB <br />blbJ) Aw wl x515 <br />(61btl) <br />(69-7( <br />,~( BAMPLE Ltis :Y ;'t¢.Y -, i ~ ~ ./ <br />~ <br />~ ... - .> ./ <br />~' <br />V' ~ i2~ r. <br />! <br />~ <br />i'ii'l <br /> MEABUREMENT , ( • ( <br />L ~):I L J ~ e c <br /> <br />,'. <br />" ~"PBRMfT .p ~ nit ;,~,:;rx'; <br /> <br /> <br />e :IS,~:`. 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O((r I!I I (Jr BAMPLE <br />I, (./ ~ l/.1~ >;:i.:;:1::y:;: IJ:;::::::::i it <br />~ 1 <br />(~ <br />( r7 <br />I <br />11 <br />,I f: (! :')tiG it f^F~~~: 1`LAt7. <br />1 MEABUREMENT _ <br />1UU`_(: I G n a.PERMIT °'. <br />~ Yw~+ <br />~ <br />~'r"€ <br />.~i~ <br />~~ <br />; '.~~(°:~'ie~a' +,"~'7~: <br />,• "A'ta'°~g <br />' <br />° i"F'~G a'• <br />°o-L?~t~s ~L <br />f" . q+nl•{~~3"~aw`fAa :1t>.i <br />' ~~^~.~~y', .•fn <br />SY <br />1:. t'F I.JFi:: I; i•Oi:i V.41,U. <br />, ISE4UlIlEMCN:Ta <br />e' x <br />. <br />q <br />~ <br />. <br />°s <br />x'3Q°<(i, <br />~ x <br />' <br />n ~ " HCC (., ~ <br />, <br />a'"sea <br />s'sas. <br />a s ce." m <br />p <br />,'s,' p <br />`xa` ; r"n <br />° <br />9 i:4 .~ <br />' h <br />a <br />a <br />a)I.T ~SF :)1'~ <br />L BAMPLE :i (: ~1 ~:1;:?: .:I i~-. ; ~ 'r ii+i <br />l n <br />•LI I <br />I <br />~ a l/'1~ <br />t <br />+ <br />~~ <br />f ' <br />hi <br />hl~t'JLYL,~ MEABUREMENT „ L , <br />I fl (~ <br />/ 11 ~_ ~+ > a ' "PENN IT + T.E~4~?t~(S4i s`" <br />e~.~ ~~sll.~'ia <br />:.i ~L. :: {F .: " <br />«",~rr'+~2~1.°~§i/iY~Po.'.° . <br />qai f'"f{:Yq :sA Yp` <br />. °REOUIREMENT. « , ce <br />y " s <br />Y 111 I a p <br />° ° _ ea <br />NAM!/TITLE PRINCIPAL [XECUTIV! OFPICER fENALTY OF LAw THAT + NAVE PERSONALLY [XAMINED <br />I CERRFY <br />UNDER <br />WITH THE INipiMATION SUBMITTED HEREIN YID MSED <br />1M <br />MI <br />W I TELEPHONE D A T E <br /> •ND 1 <br />FA <br />L <br />i <br />DN MY INQUIRY OF TN05E INpVIWALS IMMEDIATELY RESPONSIBLE FOR ~ <br />// <br />, <br /> OBTAINING THE 1NfORMATgV I BELIEVE THE SUBMITTED INFORMATION / ~ <br />• <br /> IS 1RIlE ACCURATE AND CCMPLEfE I AM AWAR[ THAT TNEwE wRE 61G ~ <br />r <br /> N6ICANT PENALTIES FOR SUBMITTING MLSE IHFp1MAi E1N INCLUDING ~ <br />VVVrrr <br /> iN[ POSSIB[rtY OF FIN[ wND IMPPISONMCrvT SE[ IB u5C f 1001 AND <br />J3uSC f IJ19 <br />drr IA <br />urNG. wP mrldr / <br />r. u <br />lu /14an <br />R <br />P SIGNATURE OF PR NCIPAL EXECUTIVE <br /> p <br />.nA <br />r. un <br />rr <br />m <br />I <br />S <br />A <br />d <br />i A <br />TYPED OR PRINTED ml,nl <br />. an <br />. <br />.rw...l <br />P.d ~~rmp..mum lmpnNmm•n/~•/A•il.wn OFFICEp OR AUT NOpIZED AGENT NUMBER YEAR MO <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rr/rrrnrr ull ullul'Amrnr! Aerr) <br />;.. ,; i'1 L:: 6. t: i. F: ~^Lr(IS (.7!'IT %VPLIFS /?h L'! If' C= 1.D-Ydr ?11-HS i'ficCI1 EYE::'f iS Ci.:..T.A'.I±G. I'r CLF.I:' A?pu;Ycrl ~'1y <br />i1 ~,/L'i'[ 1'::J E Tii l)`J IIyTi-. /11.1. llUi ,SE Ai+Y 1.L r. i) Ti) 't(Ei'Ob,'I cG 19t A5Ul; F,;.6t1': --tit:. ;..,.?;, F';: it t4D T.4t.!i)r .'; <br />'I <br />F~PK orm~ 1'(Rw.. )' /YVbdaediU n4"maybB'used. ' ' (RCrLACEe LrA IORM TNO MNIGN MAY NOT BE Ue[D.) PwGE of <br />