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P~Alry Nunr/Lmrbn Udl//[([n4 D18CHARGE MONITORING NEPO R'f /UMnI l111lSi-~~L' SJ1I._C~~EiI~.%.A_11 .~--- 1~ 17-19 C ih0lt Form A r PP ~+~U '•.wonRtnl.3. TN Y~j`L--------- ' \ 1, \17+ (SUBR 4u) kAN~1No. oooa __~ R t_A,•S TA F~-- ---~~~j~O~- •IRMIT N MR6R oncHAwc[ xvr.[R F _ FI V A L E%plres 9• 91 ----T'~---~--- ~ MONITORING PERIOD I, tIXV n1C RE1" TEST1Nra tUM UVNA ------ ~ tweturr ~ ~ _ ---------------- rcAw MO DAY Y[AR MO DAY LOCATION ~ FRDM TO y,: rlyl? NC rlsellM1.~ce ~ ~ *f~ly ' _- I l7a"79) I / NOTE: Read inlVUetiolp before eomplatinp this form. TT N 2 D Eh N S L. S T [ V F, N S 0 N P R -- S ~ 4 !7o"1)I r711J) l1~~7s) (76 " (1 Lard Only) QUANTITY OR LOADING (~ Card Only) QUALITY OR CONCENTRATION FR ECU[NGr BAM pLr PARAMR[R (b-13) (71fi1) (i8a!) (16JJ) (1141) NO E% or TYPE (11.17) ~ - AMALrBIe AVERAGE MA%IMUM' UNITa MINIMUM AVERAGE MA%IMUM VNITB 61dJ) (6148) (69.IU) P/F STATr >; -7 D AY CF7 P, SAMPLE a4 G014t1 - aaa;:ae) ( ) -- ",}OCE4fly Cr iY TY?•'.r L]< ( [)A) ~iC/ll/' , CERIODAP:INIA'-" MEASUREMENT ~ ~ Zj ~ CrPlf TGP38 1 C- .D _ ,. r ;~,aeaNiT`." `' a . :t,Ffl,@I,G?te~Dl.W. ;~, ' „A(peG~~X±b," , i ~' :##G - ~~'°te ~s ~r'r°: ~ ~ ~-°~ ~` e ° ''~e'- R. P(7R'!''= `;; ' '`±7~4ri!XZ,,!dil^: ' m 9 ASS=O '` lf;~';:` «>~ 5~' ,. F .Zq:'.'g:; - IrtQU,iR€M tM7 ~ ^ ° *'e b' <^=a' . <, x °w' ~n ~' jai' e~ =A a .~ ., . e~ '„~xm:; ' ' ~ : x,. °s. " m ~ e • ' ~;: , ;.;.,r,'`i • a 3:t : °'' EFFLUENT CROSS VALU '„ .' . , ., , ,. m ~:A~a ' ~:, , « ' .. _ ~ . , : P/F STATr:E 7DAY CHR SAMPLE C41?#OG, 4111440=) ( ) r 4 {L b ' ,40# O 4{rL=Y/r,:a ~(. 9A) ~ PM/= PIMEPHALSS~PRDt1ELAS MEASUREMENT 'NZI~ ~(i'4 . _. w~PERMIT,'•.. ... , ., {[Iafi1,YFFkG(':: r • -~ ~, .; ~'r tr...4~ ~T7t" e ~T, ~ '.k4' ,. ,:~,; :~ #.i:..dlN ~ ~ -` s ,e ~w :I)k a~ T3 • "s wq - `dl++`~ 's 3~ 55 0 ~sx ~ ~ . ~~~:•'?~n . .j{;3?z; F PFL REOUIRLMBNTn .: r>, < .~ _ ~ ,_ °e ~# .n <~~Po Po ; $ ,. ~ a ~ g ~'° ~-. s x . ~ 'p ^xg.„ °a : ;,~ - ms :; : : , ~: . UENT CRO55 VALU! n . t ° , ; ~yY~ ,a.°e , °,~ , , _ s~ ii _ GAMPLE _ .. _ _ -. dl ~ I. vw -_ : , ~' ~, . " MEABUR[M ENT ~ ~ .• ' .. ~ .~ ~' •'r.-tR1i ~T-°~+ ~' ~ ;~ ",xg_','x ~:~'ze s:a 8 °'= a x' ' .a: ~,';.:,, '>x, "•ffi: 3 ` - »x'°v''~:p sY:: 'Fi~m'4 w #s ~ # < °-r is ~~ : ."a~~ p'i "ra - «:r-.,xe: ,..°.,« .,.a°.' x p. /: '=d"e ' m Vii" I :nCp ~€ a. ;,, 3~"'.T", s~'~'.~:=;. `'a':°n . a:3 ' .. . .... REQUIREN.CNT: a , ta„ ~.A'°«a.. `° - :.a « `~" . ;1, nay, n : y" ' F a "~`~~ ~~'~ . ., a.e, :., .~.m.; .~ •-`• ,„ @ S~Q'e«i«~Pw , . , ~-`«...' :'~ e wary tt . .r .,u:. : g' ;x® s . .a z ~ ;as„ " ° >a ~~ , msw; .~~n - - SAMPLE - ~' ~ - °- '- 11 ~ - t~ - ~ 4 I - ~r _ _ MIABU REM ENT ~ - ~ ~ ~ ~ ~ e ;.~ •. .. •~ ... T n'PERYIT. ,y ....: ~,'®~e ~€..a. ~, ~: ~p ~ .-« y~ b „,,~~&; .• x.:a r« ; y°v~ s~~ ~~~~~sx F Y .,, 'x: y°>ma~8:/A~ ~'3"'~l ae =. ..~;~°'1 '.. W ra. 's.. 4's»a.°h .."p'A:;. , ~ I.-a.1'w ::.,.~'. ,x~p.~Y''n ~Y`~x° '« ~ x °gx R r AU1RElJ,ENT. ~ .e`T,a "~a .1. °~ ~ : a ce ~ ; ° , R <w SRI. ' ` ~' . :e, ~,°r s'a'. q,F:^ << $ '~'° js..,^ sY'- ^ ° ... i; ' _ 9x e ~ a her, a ~` ce, - _ . . y „ m .,°~ ° a .. a L .,ar°..,' p .n ~ : ,rw °SY. x ~ ,~x.ae• .-k ~ ", ay S i~ , > , - iC ° .P rr C :' t. 1•z1 ~ '" ~ BAM PLE ". ] `.S ' ~ [, „ ,`, •: -, ~; . _ _ •v -.. 4i I J i ". ~~ [a. -- .. MEAN REM ENT .. :~ - ~ 1 ~ •. _ _ - .- _ _ I.. '. h.:a '.P€PM 1-T.~.. ' ~a ... .. '3 'g", 'a'a.°`~ ° '~" • " " .':.~a:~.°'a'~.'o- "g"..°k'. r ~ ~ -. t _.[~ 'r -~SY,~A p'~`~'ea `-'tt ~ re a~ -a .' .. „&~a <~„~:zsg`ce . _. a; yak i..°q <`'^ ~«,';R'., $ ^:,. •~~ ra ":~ F ~~ 3R~ .xe~. e x 'a° 8:;;^ '3 -i.'.. 'r _ RSOgIREM"tRT,= ce a . ~~ ~2• ® F 3 ~ ... .. ~ ~ x ~ d '?y ?as '~ .. ... o-,, me«, : e «.r «.~oro „y ~ a; .e R°. ~~4ce ,y y ~ .r ~ ei ~; w @ ~ m ~ €a.. ;s i ,gam. . ~< °sM e .,u:ay`n °' . a- .x ^..Y .,YF a x;e . a , . . .¢ r, :..- X. ~ : ' '" SAMPLE p.. :_ _. I ~ r. _ _. L ~_: :' ^ _. ~.: j ~. I - MEASUREMENT - '- `- ' /., -.- e ~:.: ..PERM /l'~.°.s ' 8,. °a1`p Q.,~,xm6.:,e:H~ R.. ,~, xg ° g .: va)•'<n 5'c",d e9,b'~'aR ",~ ep 'A ~ _ .. '' ,. _ `&e ~Yz=-~d: ;°-d': 'a _t e pg..k~'>X. i~~ok i'Fs ~e tta'P {, , ~`~ '~ »& :. .<;.x L.~Ie ' R'RAa.,. °) II.po : "~a _ ~ .1 _. _ ~ ~ r. .$°. :_. ~ m. ~ ( .R,..e ~, R u ~ .~ - R~GUIREM>rNl( , ~. .: a,mal y =;a, as, ~Q° Y ,a .. q: ~~« ~-'~ '~ ~i:':a ~"X ~. ~ . 'd&o . - ,.E4'W `- ca - < ~.,5€;*%.°x.,:~ ~~ ik q ~ . _ S .A ~ s c. N°Y y ~ ~ r. ~' `d &'' , s L Y ~ na ~a i ~ k 7. > S&R'i° h vt'`8 '~ x - i' _ - ~ - SAMPLE _ ..l a - ~~ .r __ ._. .. i ._.x •~ _. ._ .' q iE• i _ - - . ~C ' n MEABUREM ENT ~ -. .. _ .I. . c •~ CL - _ _ ~. - ~ - U R ~ r ~za .',°..'.~. ,1'. ffip ~ ~'; ffi » -'~ x...°I;"'x « ' ~9 ` - & ¢' e.F a~~,S @-$.~~°., ~s) ~ ..f '8. ~ &~8, xtT ~ ~ ~ ~ s8 :¢.' ' 6<~:4«,k~ ~:. ~ ~%~ i k ~ _ - ~~ ~' ~' It:: ~Q~"::3 ~'F'ffi':.^c 14Rx •3 ' :'S'. { ;"a - EMENT REQ "a,6 , ~<g x=, a ,yt%- w?"a ~ ., a P.x$¢z;"r S+Y ~4 .~sa Ar A l ' .ai~ s . ': i~~?sY $ n i~w i a < . .., , NAMC/TITLE PRINCIPAL Et[C UTIVE OFFICER I CEPTI(r UND[R PEHALTr OF EAw TNAT I HAV[ p[REgNALIr E[AMINED - / TELEPHONE D A T E ~ ~ AND 11M FAMIL111R WITH TH[ INFORMATION SUBMITTED NCREIN AND MS[D ON Mr INDlI1Rr OF THOfE INOIVIWALS IMMEdATCLr R[SIONBIBLE Fpl ~ ~ ~,.[( '~ ~ ~ " ' ", - ~ Gtrt~l: (tif,Nc ~ OBIMNING THC IHFCRMRgB I B[LICVE THE SUBMITTCD INFORMATION RE I AM AWARE THAT TNCR[ AIK SIG E A D COMP A R ~W`. `/ ' _ 1 ` ' 11 '." 1 - IS TIRIC AT N E CCU CAHT PENALTIES FOR SUBMITTING MLS[ WFORMATION WCLUOING ( N - ~G,l` ~I )~ ~ ~IN=( , I I eJ T ~ IW SC~ r r+~ ~ 5 F aIONATURE OP PRINCIPAL EEECUTIVE /'r~L ~-i r~. JZ JT ~ - / l l_. . Mn A r rr. wq nrludr /nr. •p F1 TT U l9 Ir. vlldr. rA . P A A ~. YF DOR PRINTED ~ r.d~..ne.,mun lmpn.:nn~.I:l .,/Mru..nEmnnlA. rnd.i .n..r OFFICER OR AVTNORIZED AGENT NVMBER YEAR MO DA COMM [NT.AND EZPLANATION OF ANY V10LATION9 Ittr/ornrr ull uvurnmrnn nrrr/ SSE PART ~I.P^OF PF.FMIT FOR DF,?AILS OF 'PiSTr'HOCEDUkE. NP9S5" IBUICATIS 7F.ST Nk5 P6RFORt!FO 9.70 RFS'.11.T~ N°.RF. REPIF.TF.O. FTTPrI! ;'!IRC?IiTC TF~T FiFF17!iT FO H'1 TO D.•1P.. CU['IF'i nF ALL T:~FOHPATIn'J 770.".7 P' ~:9T T1` tin. EPA Form 39241 (Rev. 9-BE) Prevbue sdifione maybe used. IwepLwces eFw FowM r-.o wNlcN MwY nor Be ueeo.l Pwee or ~Cli7]/'/2Q61S-i7r1] ?