H,duy N[m[IL«I(bn IJ dIJ/nmp D15r/1AR[:L MONII VItING NEPORE IUNHI
<br />NJ(M[ pE:t ~T r-(\A I. CII (':~N"r{ 1T1 Izlnl~ ul. rol ~
<br />AgoR[O~y-~rl ~~iL)i-_____-__-_.___ ~;(~ I101' Il (^, II 1;I "~) q~DIPIB"NOr 2040.0
<br />___F(. 11 ••~("I~'~______~1~~(7~L_ -ERMIT NUMBER BIfcI,AAO[nu..Ffn F' - FT'l .a 1. Expires 9-70.91
<br />---
<br />MONITORING PERIOD
<br />PT,~I!A P..c; 'O GPA, '.c7 (; Zc.!~R
<br />-ACIUT/
<br />_ YEAR MO °wY YEAR MO DAY
<br />
<br />LOCATION FwoM
<br />L TO __
<br />a a,. „ , a
<br />~•• Nn DT`C'l[RI'F ~
<br />~
<br />'
<br />anti: D~:IIIIS L. ST F.Y cIs :i O'I tHF,SI^FNC l7D 71/ !1111/ !11731 !:6171 1:8:91 IJe Il _-
<br />NOTE: Read instruclionf bEfore campletinp this form.
<br /> (J Card Only) QUANTITY OR LOADING 11 Cnrd Only) OU ALITY OR CONCENTRATION
<br />-ARAMlT[R (16~1J) (7161) IJdaJ) 11477) (7161/ NO. fBED°u`nc. SAMPLE
<br />P
<br />(Jl-J7) E% •N.L r515 TY
<br />E
<br /> AVERAGE MA%IMUM UNITE MINIMUM AVERAGE MA%IMUM UNITS 87611 1616tl) IE0.111I
<br />I' ~~ [AMPLE
<br />MEASUREMENT • v ~~^ iY'k ~
<br />`
<br />( 1
<br />~
<br />9S ~ r.
<br />$ ~~ 7
<br />1 '1
<br />//
<br />/
<br />d
<br /> 1 O 7 ~
<br />.
<br />fi)4C'0 1 0 ^ PERNIT"
<br />r ##F?#~#
<br />" #4#a#Y , :`.-.
<br />y l
<br />~
<br />6.C,
<br />: • :", %~'Y'='O# 9.0 °ERLI Rp6
<br />EFFLU°NT :N^i`_~ VALU RlgwneMlN . a
<br /># ,
<br />SOLIDS, FOT~L SAMPLE
<br />MEASUREM
<br />T ~n•...- •.. $'k
<br />( 1 ,.^~,
<br /><
<br />C Z ( nl
<br />( /
<br />~ /],
<br />SUSPP.ND51 EN Z ~ .3o IP//.d
<br />6
<br />I)053U 1 0 ~ PERMIT ~#a~m: T7####'.[ . , ##IF### . 3.S 70 NcE/ 'RAE
<br />EFFLUENT .;ROSS YAI,II' R[OUIR[M[NT #.Z-a$ I ~r• \
<br />
<br />OLL AND .REpSF'
<br />9AMPLE
<br />--, r,-
<br />.,aa#
<br />( )
<br />:('k"a
<br />': t:#~.
<br />( 19) _
<br />y
<br />FIIECtI E:Y I'ii-f.RAY 1'1''TI MEASUREMENT
<br />OD556 1 0 ^ -l11YIT,. ##r##a `###;.#. #::;: ###### ##r##+k ].fi .onrIN 'RAti
<br />F.FFLURN GRO55 YpI.U REQUIREMENT
<br />- ##~# rrT f [r
<br />1J c
<br />L
<br />Y
<br />T
<br />
<br />IRON, TU:'~L
<br />SAMPLE
<br />•n"'•'~'„
<br />•r'•T•
<br />( )
<br />.:#'=':r -..
<br />~
<br />].7
<br />( 1 .__. .
<br />_
<br />.
<br />- --
<br />(A ~ F cl MEAHUR EM ENT ~ O ~~ ~ Or 0~ Q / /1O d~j
<br />OLC45 1 !' n P[RMIT ######r' •.#a####- ;,.. #r#ArQ#T, 3:5 `;",'=.:: 7.0- NCF,/ .RAIi
<br />EFFLUENT :;P
<br />OSS VALIJt NEgU1R[MfNT
<br />.
<br />r Yr ~
<br />E
<br />I (
<br />~'3) ###•Ya~ #•~#c#~_ .,-„^~ ( 1
<br />THRU
<br />TRF,I.TMp:17T
<br />FLaP MEASUREMENT ~[D7I Q. 31D ~
<br />Jh
<br />- sr
<br />SOD50 1 C
<br />^
<br />_ rHRNIr
<br />~ REPORT
<br />OPTI4NA:L';
<br />°,.##rgp)x-
<br />###tt##
<br />v####;~ ,
<br />':'
<br />
<br />6 LT
<br />
<br />NSTAN
<br />
<br />„ROS.; Yp.LU
<br />EFFLOEUT ''
<br />~
<br />30.., p; ,AY
<br />A ..
<br />C .. ,
<br />-: _ > '.
<br />a
<br />,;,.,;A
<br />
<br />SULIDS- :'C?~L
<br />SAMPLE
<br />4^###^^
<br />"'~f'##%
<br />
<br />( 1
<br />#####'•
<br />
<br />L
<br />
<br />ZS
<br />
<br />( 1,1
<br />
<br />b
<br />/
<br />f
<br />~O _
<br />/ d
<br />'~
<br />DISSOLVE I MEASUREMENT 31
<br />~' I 3 Z / V
<br />/,
<br />70295 1 0 0 ~ ieRMiT ~ #..'.#/stlt#w: ;..y,+r~##,~,.,'" ##O Ipijllptia#.# OP'!.I(igAL;' REPORT
<br />' TRLi • HA6
<br />
<br />EFPLUIT,NT .:PISS VpT,U' REOUIR[M EN T, ~.
<br />
<br />< p ~ ., g
<br />#;.#: g &
<br />"~ ~
<br />'
<br />r
<br />r
<br />OIL AYU ,REpSs SAMPLE *=### ( 94) #####, #;#### #;:;:.•~:# ( 1
<br />~'
<br />YISUAL MEABUREM ENT O ~ I
<br />7 V~IjV/P
<br />84066 1 0 1~ ~ PERMIT '~ `~,^~#~Lk# " 0, c ~' a Y"` R
<br />RLT ISUAL
<br />F ~ D jS A ! R[OUIRLM [NT -
<br />_ x
<br />s .,
<br />NAM[/TITL[ PRINCIPAL [%lCUTIV[ OF-IC[R ' C[Pllf• unDEB RNALTr OF LAw THAT I NAV[ -[RSONALUT uAMmED
<br />ANU AY FAMM1IAR wITN TN[ IMlp1YAl1pN SUBMITTC° NCBCIN AND BASED TELEPHONE OAT E
<br />ee~~
<br />C..~`~
<br />6°F OM MY INOVIRY OF TNDfF INDIVIDUALS IMMCp1([LY R[$1VIISIBL( IOB
<br />OB(AINIMG !NC 1Nf CNMAIIO.Y I Bf LICYF iN[ $UBMII'T(D IN, OBMANOM
<br />~
<br />
<br />~
<br />IS IRUC ACCUBAFf AND COYPLETC I AM AM.BF THAT TNFBE ABC $K, /~
<br />~( (
<br />D
<br />[n \ ~
<br />r NII IfANf PCNALTRS fOB SVRIII IING fAI S( INI ORMAIny1 InCI IIdNL _z
<br />/
<br />( ~(
<br />j
<br />r I/. ~^I
<br />r ]~ KCS'Iy1i9 p nN[ .NO IMT•BRONNL nT 5(L IB USC 1 ItDI .NO
<br />IP.n.nv. .rl.• IAr.r um+L, ^,.. ,...Id. h+...,, r.. bul. , SIGNATU E OF PRINCIPAL EIIEC UTIVE ~
<br />) ~
<br />QQG 77-I-_SZi(J
<br />-- 9-/
<br />_ . t~l ~~
<br />TYPED OR PRINTED •~•+1 •••..f,i^~^^~~^IP~~••+•^^•~I.1 A. I. ••nnn..nrA. nn.l ,..^.,I OFFICER OR AUTNORIZ EO AGENT AAA NUMBER YEAR MO DAY
<br />COMMCNT AND !%PLANATION OP ANY VIOLM ION5 INr/nrnr'r ull uum M1mrnO M1mr)
<br />DTL G GP~.pSF--''F.C FO7f47°. F• F/! P4SE 3. nR7•tLY iAMPLT`I~ LyfF'llrrrl7y5--Se°. L"1"_`T:•'1T°' n/.
<br />EPA FDrlR ~~20.1(RBT.9-BB)PrBWDUa [dIIIORa may be used. IR[-LAC[a e-w rowM TAB wNICN MAY NOT •c uslo.I -wcc or
<br />
|