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<br />OCATION _______
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<br />RwnorywL rotlalrw cNAwcx alMlnwnoN SrsrrM INPDESI
<br />OISCHARNITORING REPORT /DMRI
<br />116 77~f9
<br />PERMIT NUMBER olscn AwcE NVMPEw
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ IJ TO 7 _
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<br />h I ~~ O R Form Approved
<br />(5 U N R N N) M IDfl7fi TNo. 2040-0004
<br />F' - FI Y A L Expires 9-30.97
<br />GULCH A SERI PONS/!:OQO SFGS ;: f?
<br />NOTE: Raad instruLKiong bsfore~mdatinR this form.
<br /> (3 Card Only) QUANTITY OR LOADING (I Cord DAIy) OU ALITY OR CONCENTRATION FREOU ENCr
<br />SAMPLE
<br />PARAMR[R (1673) (316!) (J8a7) (1637) (5161) NO.
<br />Ex DF TYPE
<br />(3]77) wNALYSIS
<br /> AVERAGE MA%IMUM UNITE MINIMUM AVERAGE MA%IMUM UNITE
<br />676!1
<br />16/681
<br />(69-78)
<br />PN SAMPLE IL•{si ltQ.'t R:1rrIG~iF ( ) ;A;iffY;-.^-4` ( 12)
<br /> MEASUREMENT
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<br />NAM L/TITLE PRINOIPAL E%ECUTIV! OFPIClR LAw THAT
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<br />I NAVE PERSONALLY EEAMINED
<br />IND' AM FAMILIAR WITH 1NE INFORMATION SUBMITTED MERLIN ANO BASED TELEPNONE D A T E
<br /> ON MY INOVIRY OF THOSE INOIVIWALS IMMEDIATELY RESIOr151BLC FOR
<br /> OBIAIHING THE IMFbfMATgY I BELIEVE THE SUBMITTED INFORMATION _
<br /> IS T1M1IL ACCURATE AND CCNPLETf I AM AWARE THAT THERE wRE SIG
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<br />a.d..r maalmum.myn.nrlnlrrrl„/MIU•.n E~Ir.rwfA. •nd .: ..a..r OFFICER OR AUTHORIZED AGENT A NUMBER YEAR MO DAY
<br />GOIwq ENT ARD EAYLANATIpry OF Aryl YIOLAT IONS 1rtgOfnll Yn unUCnmlmi n[rl)
<br />FETTLERDLE SOLIDS LT!:IT APPLIES ONLY IF <= 10-Y!t, J_4-HT: P?FLIP F:VcST IS CLAI!tED. IF CLAIM .4pFROVED dY
<br />. 1•_I'I, 75; F IF~N Lft!iT5 GILL NOT P° A.PFLI`La TO RFPONTr'.D ttF'^SIIR°hIRVTS--SEE I, n,lA, F': u AvL 7. 6.LI:, +:: ~•.
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