Laserfiche WebLink
N I.11VNhL YVLLV r/V VIS411ANVL lLIYINAlIVN 4T [IEM IIY /•III'.1f <br />(Sl; fi E(:d I1 DISCHARGE NITORING REPORT (!lnlal <br />/Pr ---_~____ (1-16) (17-191 <br />/~Q [^ \ ° AZ t36U1)Z PERMR NUMBER ol[cRAl1q[RUr[aR <br />>r .c'CE ------- <br />~II(.ux • <br />(S U d R N Y) Fok04{i[ifBved. <br />F- F Z N A L OMB No. 2040.0004 <br />1. r c n u a D r c frw...ewEel,al~e aRa2[-OXD D C v <br />' ~>• el/ r1' ____~~_____ VYJVYO\\VY -rV'~1T`>:`LYr~V IIVY V\IYYR <br />MONITORING PERIOD <br />~ <br />r v <br />,F~ -f} ______~__ YE R MO DAT YEAR MO D Y <br />c ~ _ _~ti4L~_~_ 1!50L` __ _ FROM ro #h# NU DTSCHARGa' ~~ ##z' <br />~ ~ <br />A.T, <br />~ FAESIDENT (zo-n) n7-s7) O+•7s) r)e-v) (18-19) (7o-nr NOTE: Readlnstructbns6efor cs~ompletlngthlsform. <br />7 , ' (l Cud Only) QUANTITY OR bADING (1 Crrt) Only) QUALITY OR CONCENTRATION <br />FiIEgENCY <br />PARAMETER (16-37) (SI-61) (l8-IS) (16-57) (Slfil) NO. <br />E% <br />ANALrsS SAMPLE <br />TYPE <br />(77-37) <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNIT9 (r7dl! let6r! 1QR70j <br />i ~~#~~ ' ( I2) <br /> eAMPLE <br /> <br />~ MEASUREMENT <br />U04D0 I D D ... .. ,. . , .~ . <br />##tr <br /># <br />9. , <br />YEBHL• <br />6EAb <br />EFFLOENT GROSS YALU ,...~RmnENT ##Rr;~ HINIIIUtl tlAYIMUII SU ' <br /> ,;, _ . ,;. <br />r 0 BAMPIE " #~} ( <br />SUSPENDED MEASUREMENT <br /> <br />00530 1 0 O , 'pRMh e ~ F; ##a ONCE ,: B <br />EFFLUENT GROSS VALU nuwo.Er+r~ <br />~ '~; <br />rt , "• ~~ ~ C### ~ ',:30DL <br />lV 'DAILi~ <br />tl MG/L MOlIi `:?''~ <br /> , ~_ - :; ~ : . • <br />SOL1DS <br />SETTLEABLE # li;k ~I#ICI~:#~: #:14## ( 25) <br />r SAMPLE I <br /> MEASUREMENT <br />00545 1 0 0 ,: ><'$' ~;;< - ' ON <br />~" G <br />EP FLUENT GROSS VALU R <br />nuwEMENr ~- <br />'. ~ ~ _ <br />, 4### . - -~ <br />DAIL2 !I <br />C1L/L . <br />tlONT <br /> <br />: <br /> , ..ry <br /> SAMPLE ` <br />}'NEON EYTR-GRAY MET EASUREMENT <br /> <br />00556 1 0 0 •~ ' <br />PEr+wT <br />. ### . ~. ~ . <br />- <br />_ . <br />COtlTI <br />GHAd <br /> <br /> <br />EFFLUENT GROSS VALU <br />nuuTaMENr <br /> <br />, <br />: . <br />- <br />- <br />s### <br />,. = .. <br />IN5T` nA <br />NG/L <br />: _~ <br />6Ei! <br />; <br /> .; ; ., . <br />_ <br />. . . <br /> <br />1 1 <br />. <br />SAMPLE <br />f <br />~ <br /> <br />1 <br />(AS FE) MEASUREMENT <br /> <br />U1D45 I O D . <br />P C#r 'I ~ . CE GH <br />EFPLUENI GROSS VALU ERMIT x <br />nuwaMENr, ~ ; <br />; <br />' ~ ##il# ~ ~ ~:3UOA~ <br />AYG . <br />DAILY <br />~lIX tlG/L pOYTS ~~ <br /> , <br />, - .: <br />. <br />1 LO r U DUIT UR SAMPLE ( V3) iF+f~+i #%x~... Xr##~#I <br />TdAU Tk EATNENT PLAN ASUREMENT <br />SUUSU 1 0 0 <br />' •. #e## Y KL I T <br /> <br />EFFLUEbT GAOSS YALU ~ .PERMIT <br />nuIREMn+r' <br />`°30Dd~`AY.G <br />~u=DAILY.'..tlX <br />MGD <br />'< ~ <br />at4# <br />~ <br />~~ ,. ~ ; <br />~ BAMPLE ~f ' <br />UISSOLYEU MEA8UREMENT <br /> <br />%0295 1 0 0 rERMrr ~### OPTION L' BEPON ONC GAB <br />EFFLUENT GROSS YALU GuIRSMmrt :%~ <br />\..~ <br />~ <br />~ #~:~# 30D8.` YG '-.`DAILT.tl tlG/L - <br />~ 'lIONT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I CERTIFY UNDFA pENALTr OF <br />lAw <br />THAT I HAVE pER~ wLLY ExunINED <br />TELEPHONE _ <br />DAT E <br /> <br />~~~~ 1~~^~' <br />~V w AND AM FAMWR WRN T'E IHFORMATRYI $UBMATED HEREN: AND BASED <br />ON MY WOURY OF T1q$E NpIVOWLS PIMEDIATEIY RE" ~SIBLE FOR <br />OgTyyNG THE yyFORMATION 1 <br />BMITTED NF <br />R <br />ELJ <br />VE THE S <br />MT <br />N ~ <br /> <br /> <br />\ <br />- 9 <br />O <br />1 <br />g <br />E <br />U <br />15 <br />TRUE, ACCURATE AND COAPIETE I AM. AWARE TENT T1ERE ARE <br />Sx <br />MFIGNT PENALTI <br />F <br />R <br />I <br />MfTTnI <br />FA <br />BE K <br />RA <br />T1 <br />1 <br />C1 <br />n ~~ <br />~ G <br /> <br />~ <br />Q ~ ~ 1A <br />p <br />W <br />.IG <br />i <br />ES <br />O <br />S <br />H <br />G <br />L <br />O <br />UD <br />T <br />TY <br />F FN <br />AND MPRI <br />E P059B <br />ONMENT <br />E IB <br />SG 1 <br />001 AND <br />S <br />~ D <br />' <br /> /~ H <br />. <br />1 <br />U <br />O <br />E <br />S <br />E <br />U <br />1 ule <br />rwr <br />g <br />i <br />Nd <br />Fi <br />33 uSC <br />N <br />Ai <br />rh <br />ro <br />d SIGNATURE OP P NGIPAL EXECUTIVE 1/ _ <br /> <br />TYPED PRINTED ne \ <br />r <br />. <br />. ( <br />n[ <br />u un <br />er <br />n rl <br />ne <br />e <br />nn Fv <br />fIBLEO rM or m[timum imprironmenl o! berrnn 6 manlha [b S ye[n) <br />OFFICER OR UTNORIZED AGENT AREA <br />NUMBER <br />TEAR <br />MO <br />DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rekn:nce rll rllrchmenl/ here) r <br />GIL E GAdASE--FOOTNOTE F/r PG 3. SETTLEABLE SOLIDS Lii1I'P .IPFLIES ONLY IF <= 1L-YNr 24-NR 6I+ECIP EVENT I=. <br />t:LA12fED. IF CLAIM APPROVED 6Y Yl1CD, TS5 B IkON LIMITS PILL NUT dL APPLIED TU KEPOHTE;D NEASUNP.tlENTS--SEE <br />` T .- ~. <br />rDA Cn•m ,'1. 771.1 /qnV Q-AAI Prnv%nrrc pr{innn~ T°~• hn Uenr/ rRFPLACES FPn FngM T-nn U/Hlr-4 MAY N(~T RF IISFrTI ~ _ _ PA (.'F -OF <br />