-` 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,~:`. ";e~,:c~:•n
<br />•A' ;:r:~: ,.
<br />~tl
<br />+d` '
<br />°
<br />a a"
<br />a"Y'~°~~~x~'a g~ F: ° °°
<br />"°
<br />°a>
<br />old
<br />~ °:~
<br />~~•~
<br />'~
<br />'II
<br />'1"
<br />'
<br />... ,
<br />'
<br />' RBgLfIRBM lp7.
<br />a ,. ;
<br />. e
<br />.
<br />s
<br />' , ewg s
<br />>a •
<br />° „
<br />"
<br />,
<br />:
<br />; x "
<br />
<br />- .
<br />.,
<br />C
<br />":e z
<br />.,
<br />.
<br />r.: I
<br />LU..h
<br />P ~ Fb?:; J 41.1. •.,-.:..,;.,~..;., °
<br />.
<br />a
<br />, ::E
<br />~ X",'
<br />"N.
<br />, ,
<br />a..<
<br />e a+a c t ,
<br />_: ° .
<br />tl
<br />.,.)L.(u.;/r .v'?FL BAMPLE .. .~ ; ~
<br />,
<br />.'1i ~
<br />~ r,'".'
<br />, 1
<br />IY'
<br />Lrl 1.~
<br />~ ~
<br />~' I/ !
<br />I
<br />1 ~
<br />)
<br />=i
<br />'I
<br />5`Ii=PE!IGi::i
<br />MEABUREMENT
<br />`
<br />1 <
<br />L ):;?G 1. li v RSRM )T:'°
<br />°
<br />x .x~f~tt T~°}ti°d/sa°
<br />~"0 .s;~pfhk""~;"«
<br />~
<br />F
<br />~°d :{,I a`.: °. i~;.set:n &Y,ee
<br />&°A' <
<br />4
<br />~ y~, y; ;-a'•"m... «
<br />:
<br />~3
<br />f
<br />Y (~
<br />~
<br />"
<br />~
<br />`~
<br />~
<br />"
<br />~~•'
<br />Y '~': "`/+{ t
<br />Po~R+
<br />L'/~rrc '``a ~1y
<br />JiiM1
<br />
<br />-
<br />t~
<br />C7
<br />i
<br />'
<br />"
<br />.RE4VIREM 6l/T
<br />
<br />°xe° a
<br />..
<br />y
<br />"
<br />"
<br />p ,^
<br />r
<br />°
<br />
<br />::I
<br />Y y
<br />xn
<br />pq
<br />"e Aq «
<br />p° g
<br />;
<br />e
<br />.
<br />'~
<br />"~ "a i
<br />a
<br />a
<br />,
<br />q
<br />~
<br />Y
<br />. e
<br />
<br />u^
<br />°x °
<br />- ° fy
<br />
<br />.
<br />i.
<br />l ^. !,
<br />(; H
<br />- Y4l.
<br />.... ..: ..... " ".. ,.. .
<br />a, e 9
<br />n
<br />s }
<br />. s
<br />" x
<br />_ °I r
<br />)LIi1 ~, .F.TTLF:,e Lc BAMPLE
<br />REMENT
<br />MEA f,1 .; .:'.L. ,• y. .:glr~f ( 1 ~:. c:;: t:;. ... ~ .~
<br />C ~ ( ( ?5)
<br />(/ I
<br />/4r
<br />!
<br />~
<br />C.
<br /> BU . / (
<br />1
<br />L :)7~:J ]. n (~ '°•%'PERM(T''•n ;'°.+si"t~.SPp"{.: ihrrl'R" .°m 'Nfn:[ n«R'1`n
<br />~
<br />~ p :h{r :r
<br />.
<br />Yx ,L~
<br />3°!3,`JtS{d`x%
<br />°
<br />~ ism°h'i§~ivN w'.Fs°a
<br />~
<br />. 1' n;•r
<br />'°: }'~~§°x•~: ce.`
<br />a 'o-; ,;mss:
<br />°; " 's '•
<br />i
<br />'
<br />~~i
<br />°° Yom. ..
<br />ri
<br />F~
<br />Y
<br />
<br />. r 'RBQUIREN lNT'
<br />n&
<br />,'s . °
<br />n;
<br />s a
<br />" a a.
<br />¢
<br />`.+
<br />i p
<br />«
<br />a
<br />"
<br />"
<br />.°»
<br />"N
<br />-~
<br />p
<br />an •*
<br />':
<br />'
<br />°i
<br />'
<br />b v .
<br />°' ~
<br />.
<br />„ .
<br />g
<br />'
<br />L
<br />n 1
<br />..
<br />'.. p
<br />« a
<br />Po
<br />e
<br />° kl;::: ,
<br />a
<br />x
<br />x
<br />n ,
<br />a
<br />s n
<br />x Y a
<br />I~.l. h'~L .'.~ ~ ~ Cp._ BAMPLB .::%~:: r ( , rte:(.:. ~... ~ L`I~
<br />I.ILL tI F.:\K-r NA.Y rF•'f' MEABUREMENT (..'~~~ l-C '•i. ~'I~n~
<br />G') ` .I ~ n ^I
<br />~ I _ -....., ..
<br />"'PI;RMI'f"• ::.ti~rgx:~5:,e"-
<br />;&
<br /><,%,,.~r^,s~f~t°x :t t: =®eg~," §~p
<br />~ Tf
<br />°'.
<br />~
<br />~~ ~': s ~L°
<br />-T"vr`
<br />q
<br />.:
<br />"t. Q^
<br />~'
<br />~a
<br />x "
<br />~q % °
<br />p;
<br />~~~ :~_
<br />p °~e;aj Po °i",
<br />~ ~
<br />tY
<br />'~r ` ~ 'I
<br />L~i~:'U
<br />'
<br />"
<br />'
<br />'
<br />~ R¢4U11~EM ENT e
<br />«
<br />°'°
<br />'" ee
<br />xe
<br />a
<br />xn
<br />"°
<br />; ye
<br />X,s
<br />R.,
<br />"I*n' ~ q
<br />F.
<br />F
<br />r
<br />lllf:[;1
<br />GR15n YnLf) ,:~::
<br />r
<br />~ ~ r
<br />R' s.
<br />) .{i) I, r i(/ i A t 9AM PLE l::V:;::j'::> ~
<br />' ,. v, ~..a
<br />Yt i:. 1'
<br />I ~
<br />) %
<br />(
<br />~
<br />! /
<br />\ ~ 31 /`I
<br />I
<br />~
<br />C
<br />`R ~~.'
<br />{ MEABUREMENT ~ I ~. ~
<br />.
<br />- ~ t.-
<br />'JC ll.
<br />r~ /~
<br />(Ill/(iJ ~ \.+ l,l en ..p
<br />'PERMIT'
<br />": 99yyA,~yAyb
<br />a.6R!~L~A
<br />_R" .~4y ~i
<br />"i~r+`. YVVry
<br /><r "
<br />~x A
<br />~'oR :1"' ):
<br />.::: Jy y`>.° IY :Y'
<br />L`Fn3.3`Po ~,P" ~
<br />•~i"~.°q': <:x 9.;p,' 4.y ~~.Y
<br />•'h i
<br />~'<'..`b ''a
<br />~ ~' '~"
<br />~~w ~>1r`q
<br />t[Z ~f
<br />L
<br />-
<br />'
<br />'
<br />'
<br />` '~lSgU1R~lA8NT
<br />~~
<br />°;
<br />°;
<br />;
<br />: e
<br />x
<br />. x
<br />x sa
<br />`4 .
<br />,
<br />.a,ce •, n„T
<br />•"
<br />` ~ .
<br />_;°~'•
<br />t/ALI1.
<br />i.i
<br />i.UL
<br />t:i ;;5~)5
<br />i
<br />~ A
<br />n
<br />g~
<br />R•
<br />a ::tG;:. ° 1 . „r :~ +
<br />i.CI t.F
<br />1i: (. 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 />
|