Laserfiche WebLink
~ ~ <br />IIRC1YAc <br />:RMITTEE NAME/ADD NATIONAL POLLUTANT DIECN <br />E ELIMINATION srarew (NPOf51 <br />rilitl A'.Ime/Location i! diflercntl DISCHARGE MONITORING REPORT I DMR) <br />1ME . Q o-w ! Mp <br />-~~S•~yf <br />+L~j- T _ <br />13 <br />l'~~-'1 <br />S` >- <br />-- /-161 117-19) <br />~ <br />, <br />. <br />. <br />- <br />-. <br />7ORE551 '~;t l 12D.T~3~ IJ.T.C --------- -- (- I' 7 ^ <br />l <br /> <br />- F;.1 ;yj~:,~`- ~'~ 4~, X1',]1 <br />-- <br />PERMT NUMBER c RAwcc <br />nuw <br />ou aFw <br />-------------------- MONITORING PERIOD <br />CILITY ~I // TEAR MO DAY YEAR MO DAY <br />CATION ~~,yZ4~'_~.G~4~'fti ---- FROM ~~ n1 TD 71l 1~ ~ <br />w Rn. •.:-,. ,.Te r _ eTlcv=eau BDCern~ar Haiti /n-nl t~J-zsl nA-771 ra-±vl Hain <br />C~ <br />3 ,- ,t ~ <br />(S i l P. '7 .I) FRrr~rlpproved. <br />.. _ tr ` v ~ ~ OMB No. 2040.0004 <br />1••1).^E 7F.T -APWp~'pl~~l~~-~14~~ <br />NOTE: Read Instructions before omDletina this form. <br /> ' (J Cab Only) QU NTITY OR LOADING (1 Cab Only1 QUALITY OR CONCENTRATION <br />PARAMETER (16-S1) (3161) lJ8-15) 146-SJI (5161) NO. FRE ~Fxr 9AMPLE ii <br /> <br />EX <br />ANA <br />r515 i <br />TYPE <br />IlJ-371 L <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNIT <br />S le:4Jl re1681 tes-ror <br />.. ~ .il:t*J.C, l'31I 17. I>~l SAMPLE "##~±: ##:~r: r... .~ Yr-~ •f <br />( ~J~ <br /> <br />~t:2IO~S?d~I.l MEASUREMENT <br />.°3 ! ~ 0 PERMrt F####O -.4#."-### CSY T3PORT -Lr}k.# #¢Y#i`•r ~ .- ~Ef'I- RAR <br /> <br />^L'?•;* ~I; 1°; Y1; ~ • REQUSiEMENT. <br />- <br />mot.: <br />h n• <br />r~•vn <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMR . <br /> REQUIREMENT <br /> 9AMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT.' .. <br /> 6AMPLE <br /> MEASUREMENT <br /> PERMrt' ~. ~, ~~ <br /> REQUIREMENT - <br /> 9AMPLE <br /> MEASUREMENT <br /> PEAMR <br /> REQUIREMENT ~ ~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUSiEMENT . <br /> 9AMPLE <br /> MEASUREMENT <br /> PERMrt~ ...: ei .. <br /> REQUWEMPJli' - ~ ~ .. <br />ME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERnFY UNDER PENALTY OF LAw nMT I NAVE PERSONALLY ExAMINED <br />AND AM FAMLIAR WTI T!E aFpiMATx?I SUBMRTED <br />AND S/SED <br />ERE TELEPHONE D A T E <br />r <br />~ <br />L~ N <br />RF. <br />CN MY INOLIPY CF TIOSE NDVOlYL6 MMEDNTELY gESPONSIXE FOR <br />Li O~ <br />~Iti <br />~C ~l p@rARIWD THE IFQIMATI~YI I ~LIEVE THE $UBMTTEp INFORMATION I$ <br /> TRUE ACCURATE A!A COMPLETE I AM AWARE THAT THERE ARE <br />SLNFGM PENIILTIFS iOR SU®ARTPID FAL <br />E WFCRMATgN <br />INCLUpNG <br />• <br /> <br />V~ ~O ~ ~ . <br />.. <br />PDssI <br />TNE <br />Lrt <br />M <br />E <br />r <br />l 7,, <br />/~ Z7 <br />J~ <br />~I S <br />~ <br /> , <br />U <br />310 (pevnlr. altlu tlwr <br />r <br />! uR~rru <br />inrluCe <br />lmu <br />u <br />ro SIGNATURE OFPRI IPALEXECUTIVE .3 ,// `~ <br />TYPED OR RINTED' , <br />p <br />Y <br />(10000 aM a IlMUmum impri.olumnt o! hrrnen a mpnrlu Fne 1 ye.nl OFFICER OR AU NORIZED AGENT p` EA NUMBER YEAR MO DAY <br />MMCNI qNp GRYLANg11VN VI' I.NI VIVVgI N1Yi IIICICICIICC N .IMCIIT[IIIi IFT/ <br />'E PARE I. 9.S.P0R DETAILS OF TBST PRD.:EDDRP.. REPOE* LOffESi D'LOTZ~R (~ EFFLOSVT) VHICR IS LE?H~L TO <br />~F TEST OR6ABISf3S (LC50) AHD ATTACK Acore TOIICITS ?F.ST R?PORT FORM T7 DAR. C:1PI.P.S OP ALL <br /> <br />