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1'CRMITTIE NAME/ADOR Ia! //n((Ydf <br />' ardrty Nome/Locplbn i (renl/ <br />'TnME_ °E'L_ 4U.^_L~:2151;J~C? II)____ <br />n Dgnnf~~ I_fl~~[,_ _ _ ___ <br />rA_iurr --------- - ---- <br />LOCATION <br />~~, ll'r:: C'r; IiI i L. S~4Y[r.••~:rl'IJ P4 CtirI1F!JP <br />NAnonAL rouuTANr oncw ARCC ttIYlnAnoR arar[M rNPDESI <br />DISCRARG NITORING REPORT/l1.17R1 <br />1 fb 1719 ~! r!'1rr Farm Appro <br />CO~il7(;rr2„ rH.R~ (n'r,? Y'd) ':DrIIBTrIO. zo - ooa <br />IERMIT NUM9[R tsuMau <br />t' T '! q I, Expires 9-30-91 <br />MONITORING PERIOD DID(. rr't '•~%~ ~~n "°r~t~cr_]'1 CP°1R <br />YEAR MO DAY YEAR M AY ~ __ <br />FROM ,J '1 TO i •"'~"~ 1•n D?':';:.I ~nr, ~,, ::a.. <br />I ~_I <br />rza ul rzaul rz1 zsl rzh~vl I ~x col I m 111 NOTE: Read ilntnlctiom betore EomDletina this form. <br /> (J Card Onll') QUANTITY OR LOADING V Cmd Only) QUALITY OR CONCENTRATION ~ <br />PARAMETER (16~T1) ITT hI) 118-IJ) 116-JJ) (J161) NO. Ew[OU CNC• <br />Dr 6AMPLE i <br />TYPE ' <br />(J7 J7) Ex I'u rsls <br /> AVERAGE MAXIMUM UNIT6 MINIMUM AVERAGE MA%IMUM UfIITS <br /> <br />{ I 6AMPLE <br />MEA9UREM ENT s • •. ~ r .- <br />~ I <br />~/ y~ .- :Y fF ~ r <br />/ r <br />J ~J ` G I O ~/~' D CJ /r (%'. <br />•• <br />1, ~Ilr 1) I J ..) ..PERMIT ~rvi-;~'TYv +r-iTk:4o;:+,: .;::~ ~[~ vY{~~:Y'-$d: Oltl tiCF <br />1 •3AE <br />r <br />-eru~:r+r rrto~~ Y4i.1 REgUIREM CNT <br />.. . <br />' <br />:r-~: <br />~.*II "' <br />F'+° X11'1 . <br /> <br />I <br />_ <br />l~.7}F rr. 71: fl IIIP 7'r' 6AMPLE ~ IJ 3) .-.- ~ 1 <br />1 aril I`),L T °^ri'r PLAIT MEA6UREMENT // <br />DF Ol7gs nn~1/ <br />b. V `/ ~ ~ ~V -IN-iI/I <br />5)7El 1 1 ^ ='bcpMlT '' <br />R <br />RHO <br />NT R$P4RT.:: npT.I09PL t~xr~c=Y'. ~:;d;:>x# :;:,;:•,~•:r ,f ::;:-:.~ ACE/ NSTAtt <br /> <br />r.~er <br />u~.r:r doss vnLnr UI <br />EM H <br />-r, ~~ ' <br />. <br />- <br />, `~II!i; <br />? <br /> 6AMPLE -•--"'--".,. ..- ` Ofr) <br />~ -~s-.,--,...--•' ...:...... v.. <br />" Y' ~;•-s..., .. +. <br />" ~ ' 1 . <br />Vr.i rrA r. MEASUREMENT O O / 3D ~/SDiK-- <br />b40[•6 1 1 r? PERMIT. .. <br />REQUIREMENT #~4.##: <br />:.• .•.~ Q;, .. :.. <br />~. £S=1 4`.#~'{~: <br />' .. L:;.;e;=Yr. .-;:~':':rc r.:xr: Cs <br /> <br />~, <br />/ <br />ISQAL <br />rL~Fr.{Iisiir °r,oss var.ilf .: .. ., <br />~ <br />~w (_ .: <br />. 7H <br /> . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ <br />' .. .. <br />~ <br />:' •:.~:. .... ..... <br />....~~' .. ....,... <br /> REQUIREMENT. •, <br />. . <br /> 9AMPLE <br /> MEA6UREMENT <br /> ''. PERM IT~ ~ ~ ~ ~ ~ ~' <br /> RHOVIREN HNT ,. .. <br /> 6AMPLE <br /> MEA6UREMENT <br /> ...:. ..5. <br />•...^ <br />.., .. <br /> REOUIREM ENT ^'• °'•' <br /> . <br /> 9AMPLE <br /> MEASUREMENT <br /> ^ ~ ~ P E R M 1 T ^ ~ ~ <br />"' .•~:' <br />'" <br />.. ~ ~ ~ ~ ~ <br />~ ~ ~ ' <br />. <br /> REOUIREM HNT: .? <br />. ~ ~ <br />NAME/TITLE PRINCIPAL E%EC UTIVE OFFICER <br />' I C[RUrr UNDER FCN1LTr OF uw IN1T 1 NAVE <br />a[RSONALLr [XAMIN[D <br />AND AM FIMILIAR WIIN THE IN[ORMAl10N $ <br />fiM <br />TT TELEPHONE D A T E <br /> <br />1.1 Q -~ I <br />U <br />(O HEPEIN AryD BASED <br />ON MY INQUIRY Ol [HOSE INpVIDUALS IMM[pATELY R[SPGNSrBLE FOR <br />W <br />GaT-Y OBTAINING THE INFORMALIO.V 1 BCLI[VE !N[ $V BYITIfD INFOPMITION <br />T <br /> 5 TRUC JCCURAIC ANO COMPERE I AM AWARE TM4T TN[RC AR[ 51G / <br /> MfIUNi P[rygT25 FOR SUBMITTING FALS[ INFORMATION INCLUDING 4 i ~ <br />cc <br />~Jv f~l a- rn+;fbrtnel~*.I h~~lYS THC POSSIBn IiY OF FIN[ AND IMPRISONM[Nl $C[ I6 U$E 1 1001 AND <br />DUSC 11L9 rP <br />Ar <br />lb <br />V <br />I <br />m <br />SIGNATU OF PRINCIPAL E%ECUTIVE <br />~~ -N~ fq ~T}~' <br />%7'.JZ~J <br />3 qyI <br /> <br />TYPED OR PRINTED .. F <br />.nn <br />.. e.u <br />.. I <br />O <br />L. nv. w.ldr /,n.. up n, llu uXr <br />md,n ma nm.mm,pn...•m,.uh.l A, Inr.n%m,.nrA. and: van' <br />OFFICER OR AUTHORIZED AGENT <br />A E• <br />NUMBER <br />YEAR _V ! <br />MO _ __ <br />DAY <br />. nu uc..~ ..... ~...-. --.. ~...-. .-~ --.-. ... _. ... .. Qn <br />II Ir. ~ GH ASF.--SPA: FODrrDt.: P/, FAGS 3. ;IIrTZLY 3Af1PLip('. Tr~3TRlI,Tr~`'.;--FOOT'ln~r'C n/, <br />7320.1 (Rsv. 988) P/6YIGU46dilion9 may De used. IR LFLAC ES EPw ronY r~Aa wMTCR MAY nor PC Dsc D.l PACe of <br />.rn -nrri~~..l- 1 T <br />