|
F[RMITT[E NAME(ADOREF! (InrlYd( NATIONI,L rO LLUTw NT DIlCH11RGE LLIN IN wT10N .Y ST[M INyIJt.SI
<br />Fariltry N%TnrlLota/bn IJdlffnenE/ DISCHARGE MONITORING REPORT /DMRI
<br />!LA~_.....LJ1..~1~Y1ZL'L~i.-11:~J~.~'----_ ~- 1~/d J~ r' [ is i I.+
<br />ADDREft ~~ '
<br />('r II IS :( 9:i)
<br />~~ ti~1.___8 T l,~t ~' ~ ~ ^___ `_ I PERMIT AUMBBR I l Onc n.wce nur.rn I _ i~ I !~ A L
<br />Form Approved
<br />°:OAtB': No. 2040-0004
<br />E%plres 9.30-91
<br />-_- r,rl:l~t_____-_- ~ '! SLIT MONITORING PERIOD ~•I!1.f:11 F .i!•;111 i'l•fIU/l~l)i4(1 .`.Fl;:. l-It
<br />rwuurr___ _____________
<br />YEAR MO DAY YEAR MO DAY
<br />LOCATION _ FROM 1 J 1 TO 't IJ' 1• :::i: ll(1 Illc('HRk(''' I I v+'„
<br />,
<br />-------
<br />NOTE; RaEd inttructiont Mfora olplBtiny this form.
<br />II0.171 /71~7)I (1~~731 116 I l1E~19/ 16 I
<br />" f `J~ ' 1( .' R A . G I„ A° ~ T ~I'; ~';
<br /> (3 Card Only) CUANTITY OR LOA OINO (I Cord Only) gUALITY OR CONCENTRATION Ew EOUEnCT
<br />PARAMlT[A (1633) ISIfiI) (38J3) (16J31 (3161) NO.
<br />E% or BAMPLE
<br />TYPE
<br />(3J 37j wNwL rsl9
<br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS
<br />6763
<br />1 (61681
<br />f64.70)
<br />.1 BAMPLE :. ,: T.y,i= ~ Jf .:' 'r..: {: :;: ~ j ,~
<br /> MEASUREMENT
<br />141 O L 1) U
<br />• •/'PERMIT ~ Pt/~F~'r'v`!r.'. ~'"t [p(i[rGh~.~
<br />~ #"-[e C/~. .mil t. t;~,': ~~' ~I~At~.,.li k:r'~ :(~i~l~
<br />`~~•."~/-t-~' 'fr~~LY ~RA.~-~~. ;•
<br /> RECDIRBM ENT ~ .
<br />. I': 11 F; I1 ~ 75~ YA ,11: .. 4
<br />:~i,'
<br />
<br />11.1I).rJE .'() i Rl.
<br />BAMPLE
<br />:f :;. ,: y:l:
<br />~ ii i=, /
<br />l ~
<br />:L *;.:Y ~: .::'.: //
<br />l 14~
<br />'. I ~( ENLtIr MEASUREMENT
<br />,'. i1 j (' (! -Penwlr`" =~e~iLLrti~,Yx~ #1T:7+A!7#'.: ?r:f;: ~:-:%YCbki~a..
<br />>'
<br />'-''' .3. _
<br />~: r~. ~
<br />~~ `
<br />/ 7:
<br />;z
<br />'
<br />l'i
<br />~.~~' .
<br />r. LflchT Gk~S, YALW REOUIREM HNT [^=e;;{T .
<br />,. . ,
<br />.
<br />,
<br />.'n~:' ,
<br />.
<br />,
<br />,
<br />Jl.lfiSE .iE1TLFA!:LF. BAMPLE [::::;:~[: j t~:i!:.} / t
<br />1 : ,.: L:~:`: L.L::r::' ~ /5'
<br /> MEASUREMENT
<br />f '.~', 1: i 1 (` 0 `.''irizi+ei'.=°: ' ~..~?C•att*j; ,°::iC,ti{i z.
<br />¢i`+:~. ~,:'~ ;.t vf.~
<br />~~.4!x#4 :'i±k:e ~:~k ': ~fi :'S'
<br />''.p
<br />~ ~~~;;: dC6C: /~~; RAF+:
<br />
<br />i F' I.U=11T GAUSS A1.111 pEQU1REM ENT.
<br />-.~.... :. ~,.
<br />..:.....,..-';':;;'
<br />°. ,
<br />~?>: ;::;',.;:;;'
<br />yt ry:}[: . ,.
<br />:
<br />..
<br />,.1 :. ANU ::F:FAS`' BAMPLE t:f,':T}:;:: ;T :':!::;:.).: ~ ~ 'i[:':{:j:.r r::[:iF:l[: ~ jq),
<br />I :f i.VN t. )l I'H-G P.AY YETI MEASUREMENT
<br />i rl'i'.p L () <] RERMIT.; '
<br />:
<br />~ !:':
<br />:;1f ~wf.'~{S ..; rK~~A~rt'f ~
<br />' 4~.`•v ~!:'1`r#~::~
<br />~^~='~.4 ':Li~f ~,
<br />-'tk 44
<br />~.~ ~
<br />~~'~~:
<br />.
<br />'~
<br />1~
<br />~
<br />6 ~
<br />'~' 1
<br />'1
<br />111 ~
<br />~ iV~~~~
<br />v .
<br />R3;G1U1REM EN7 .
<br />~ : .
<br />. .
<br />, .
<br />.
<br />.
<br />.
<br />.
<br />,
<br />1
<br />~ .
<br />.
<br />:
<br />.
<br />11i.)I:f TUI'AL SAMPLE >F[L[:i:i ~}'%t;:.',o~t{t ~ ~ #4t,:;~.
<br />:: ( 1.11
<br />(A~ F'L'•' MEASUREMENT .
<br />
<br />r
<br />
<br />l,1 NJ L () ~
<br />
<br />
<br />
<br />, ~.
<br />p,
<br />;.1!kRMIT.r: °
<br />
<br />
<br />
<br />
<br />.
<br />'.'1F .$
<br />;
<br />"
<br />
<br />
<br />
<br />.
<br />rkJ?±;tG
<br />x
<br />
<br />F
<br />#.h
<br />
<br />
<br />'n. FlriL~.~~:~
<br />
<br />~'e <°
<br />rJ a'r.•x.n.
<br />•~i
<br />
<br />
<br />°,'(.'.°:,
<br />~p••:~v':z .y"
<br />Y^
<br />
<br />
<br />
<br />°
<br />
<br />
<br />[~~:
<br />
<br />
<br />~~:~.
<br />
<br />I r'FI f1ENT GROSS YA Ul R¢QUIpkM ENT:
<br />r.:::;.:.;.;e:~ '::;:e ;;
<br />[:
<br />°~`'-:;
<br />t:a.;.,.,... '....: e
<br />~'
<br />•-'<'°~•"- ~`' ~'
<br />#C[rC , ,
<br />.
<br />"a, -A
<br />°>
<br />m
<br />:~s; a
<br />a
<br />
<br />FLr14f IN CUNDIIiT UA BAMPLE ~ [/]' [[:L;F'Yk:t 'f X`.[::;+~:' [::%:I,fri•Y
<br />111(U 2HF';1TnENT PLAN MEASUREMENT
<br />:IUSO 1 rj o 'sPiaiiii~r
<br />- a~x=%ar~~c~t' =RBPif ..r(~.: -:ala:~~~w ~:~~€a~a~.. ~>d~a~~°a?~~a: o f[° ° =
<br />±~-
<br />~~l6 ~
<br />'k~
<br />T)k
<br />o
<br />U
<br />U
<br />II
<br />' .
<br />.pkt7U1NEM EN.f. ~`pa.-;;.;.,;.a; n£.°.•":.•~ •:
<br />~"•
<br />•' `i%
<br />A~.:s;."' a
<br />°dg ~ ,
<br />:
<br />..f., ,~
<br />°'''"""' .
<br />.
<br />FF
<br />iL
<br />F.NT GH
<br />So YRL
<br />F ...
<br />:a . G ..
<br /><
<br />:.,)LIDS, 'T'OTAL SAMPLE [i[: {t it r,; ~: r/:Tzi {: +i .`- ~ ~ ::: "J 44 ~-}[; ~~yL r'~r ~ 1?~
<br />I' L J~ OLYEU MEASUREMENT
<br />7 J?EIS L C (' i~pERNit~`'~ :.'~dtiglCtr71R;:'.~ . ~'~::i?P!71?Cti:*+:+.:; [En [: ~;:4>'irX!'sIC.Si:~i: ~ "~"?X%~li4r~~ 'Y:.~,, . r,
<br />( f'I l.UENT GP(1S ri Y I!1; ! REQUIpEMEMT: ~.
<br />~ .
<br />~ [; ~'r,:.'--: </'s~;!.,':;':S :
<br />"
<br />HAME/TITLE PRINCI-AL E%ECUTIVE OFFICER NAV[ vETrBONALLr F1lAMIN[D
<br />I cfwTlEr UNDER PEAV1L Tr
<br />Of LAw THAT 1
<br />M
<br />REI
<br />BASED
<br />N
<br />BM
<br />D TlLEPNONE D A 7 E
<br />
<br />JtLI
<br />IIAkll G
<br />ATF:INSUN ATIO
<br />ITTE
<br />Nf
<br />N AND
<br />AHD AM lAMILIAR MTN THE MfOR
<br />SU
<br />ON MY INOWRY OE TN05C MDIVIWALS IMMCCMATELY Rf SfVIISIBL( !Gq
<br />T
<br />~
<br />'
<br />.
<br />. ION
<br />OBIMNWG THE INE011MAT101 I BELIEV[ THC SUBMITTED INrOR4.
<br />wT
<br />D COM
<br />RE I .M wW.RC THAT 1NERC ARC SIG
<br />C
<br />. ~
<br />/
<br />~
<br />"
<br />
<br />VP I.ANI)/ENVIkONEMTNAL AFFAIR IS TRUE AC
<br />UR
<br />N
<br />PE
<br />C
<br />NInc.HT PENALTIES EoR sVBMITTING E,I SE INr ORM.r1pN NY<"LDaNL f ~/ ~ ~., r_ .~ 303 024-445 92 IO 14
<br /> rnE POSSIBILnr or fm[ AND nvwgOHMfNT 5[[ IB u5f f Ippl wH0
<br />Elrr nn
<br />SC 1 r]19
<br />A
<br />mi
<br />l
<br />e
<br />]]
<br />P
<br />l
<br />d
<br />d
<br />I BION ATURE OF RINCIPAL E%ECUTIVE
<br />-
<br /> er I
<br />rr rb
<br />n m r mr
<br />r
<br />mr uV
<br />~
<br />u
<br />r
<br />rm
<br />wr. un
<br />u
<br />~ A A
<br />TYPED OR PRINTED .•u/..r mr uw,.m,nunu•.rmr.rr••/M~ru..n 6~n.~nrA. and .i ~.v... OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY i
<br />COMMENT AND glPLANATION OF ANY VIOLATIONa (Rr/rrrnrr ull WmohlNrnU hrrq
<br />L1'TL~API.P SOLi.DS LT/'T C APPL[F:5 ONLY IF' C= LO-YR, 2(1-HP PAi•:~TP fV5;NT IS CLAI',F'!J. TP ~LATn APPRnVCD OY
<br />.I.l.'I I'~.+ ~ IRUN LIMiTti MLLE NOT gF. APuL[Pp TU dcF01,j~i-:D tiF.45UAF.Gt:I,l'S--SF'F; i.P.jA, PG 4 Al.'D IFN~C, fG L.
<br />. ._.-_-~ ~~ T- _ . e r
<br />
|