Laserfiche WebLink
r[wMlrrs[ NwrA.~1 ~ ~ )Dw[s[ /lnclBd[ <br />Fardlry Nalnl/Lopli IfIIn[nLJ <br />+ MS- rr; l I., Y1~11Li1N.i1Y------- <br />~DDREn1:L1L11-.Y1.=1~----- --- --- <br />--- Nf F l 1-L--------_CIL'?1LJL- <br />-ACI LITY-_-_-.~-----_ ---_-_ <br />LOCATION __ _---__-- <br />t r 1. L H 1' II e a Il C Y ~r :: I A . I N <br />Nn TION wI iO LLUTPN ICH.RG[ [LIMIry I1 TION SYSTEM /NPOf:'J/ <br />D ISCHARG' ~)N)70RING REPORT /DMkI <br />1l6 1719 <br /> <br /> (ERMIT NUMw[R o~ECN nwct nuHPew <br /> <br /> MONITORING PERIOD <br /> YEAR MO DAV YEAR MO DAY <br />iROM <br /> 110.111 /17731 /71~1JI /16~ I !78.191 I 11 <br />I <br />r.; ~Ir,;~l Form Approveu- <br />(:, I! f~. it 'f 6) ,: rOMA TNo. 2D40-0004 <br />h~ - i' 1 if ! I. E%plres 9.30-91 <br />I:'l i. r: 11 :1 ~%UI E'Uni//I;~IrJ li ..°Pr, ,~ i 1 <br />NOTE: Re[d instruction[ ffafor~DfetinB this form. <br /> (J CYrd OnfY) QUANTITY OR LOADING (1 CY/d (Inly) pUALITY OR CONCENTRATION <br /> <br />-AwAMETER <br />(16-J)) (11fi1) <br />(Je,IJ) (16~SJ) (JIfi!) <br />NO. <br />% fRFOU ENCY <br />Df <br />SAMPLE <br />TYPE <br />(37-J7) E wrywLr515 <br /> AVERAGE MA%IM UM UNITS MINIMUM AVERAGE MA%IM UM UNITE 6161 1 (61EC) (69-7U) <br />• i I. A :EU . li F~ A ~ F. SAMPLE I;: L'::: :;:.',: ~ .111 { <br />/ :; Y: :::: :.+:i :`K: ;:;~:]:.- .. :.I <br />1 .i (, A E, MEABUREMENT <br />'1111 () 1 C 0 :~PBRMIT '~tY {T QI .h.~. <br />p;;1r; <br />` t~:=1 ~~1;: tr b41 Y=+) ~ ~~.Q+~A"fk?~!Rt~°' ~~!:(~~~ <br />':~F.?il ali~f. :{: S: f: <br />`:. <br />• <br />,gP'Ktt <br />~ISUAL <br /> RBQUIRENLNT ;„ . iz;i : <br />C c 111 <br />e T I. ~I~ <br /> BAMPL[ <br /> MEABUREMENT <br /> <br />.. <br />.•1°ERMIT~ aT ..;;; ~ <br />. . <br />; <br />- : °r ~A~ Y~ 'i <br /> 1110 U pE 8ti <br />q ! M T <br /> <br />. <br />,. .: <br />''a <br />.~ , <br /> <br /> SAMPLE <br /> MEABUREMENT <br /> '-ERMIT- ,~. <br /> ~'RBQUIRBM eNT' <br /> <br /> SAMPLE <br /> MEABUREMENT <br /> FERMI <br /> <br />fi <br />~u ~., <br />`^ <br /> <br />R <br />EawpeM El+r <br /> <br /> <br /> <br />.: <br />-'-1 <br />r. e 3w <br />; k <br />i <br /> <br /> SAMPLE <br /> MEABUREMENT <br /> -ERMIT:•' °~~ ° <br /> p UI HT <br />8 8M6 <br />4 R <br /> <br /> SAMPLE <br /> MEABUREMENT <br /> .::-QpM1Y <br />'i <br />• :~'" °d° .t <br />' :6e'4,a.e pJ.` ire .SAT <br />„ <br />' <br />~ <br />Y v.tl• roen6'~- <br />Vi <br />^'"- . „ti <br />r` +'e3"`ke ~ nry'~~~- <br /> . <br />1 <br />'~ <br />BLiU PBM KNT' . <br /> <br />aa <br /> <br />( <br />~p <br />';a <br />: a; id F <br />t.+a,. I:r." e° Y. > <br /> <br />¢ d <br /> SAMPLE <br /> MEABUREMENT <br /> •'FBRMIT.' - <br />• <br />` <br /> lfeQU1RRMENT' <br />G s <br />. <br /> <br />~ <br /> ^ . <br />°- <br />NAM[/TITLE PRINCIPAL [%[GUTIV[ OFFICER I C[RTlfr uhDER PENALTY DF LAW THAT I HAVE P[prAry+LLY EaAMInCD <br />AND AN FAMILIAR WITH iNE Inf ORMATION SUBYIR[O H[REIN AHD BA9[D TELEPHONE OAT E <br /> OH MY INQUIRY OF 1H05E INOVIDUAIS n1MLOlAT[LY RI SPONSIBLf fps <br />~ <br />r. ~•T~1` / <br />IZILrE IIfIW V. ATKINSUN OBTAINING THE INFORMATIO`I I B[LIC VE iNE SVBMIi T[O INFORMATpN / <br />/-- j <br /> <br />VI' LANll/EtJVIRONEI4TNAL AFFAIR IS TRUE +000RATE AND CONRETC I AM AWARE 1HAT THERE ARC SIG <br />NIf1uHT RNwLTIrs foR weYITTINC f+LSE INfoRMwTION mnDr]1NG <br />~ ' ` " " <br />303 ©24 <br />4451 <br />92 <br />lU <br />14 <br /> THE Po551&uTr OE FINE wryD IMPRr.OnMENi SF[ IB u5C f 1001 wnD <br />3J USC 11]19 IAnalnr. undo IArv emmlr. war urlYdr /•nr. Y <br />n. flu r+ai 61GNATURE OF PRINCIPAL E%ECUTIVE - <br /> <br />TYPED OR IRINTED <br />V <br />o.w ~..naY.r.m.n~r•.••~n.nl~r../A.ru..n 6+,..nrA. Y.b.i ...... <br />OFFICER OR AUTHORIZED AGENT <br />A A <br />NUMBER <br />YEAR <br />MO _ <br />DAY <br />L VIn Iw L1./ IIryY LJIrL1.N/IIIVN Vf rINT YIVLn 11VN3 Ill r/(IEn~[Yll ullYtnnl(nV n.r.l <br />.;;'11LEAfY;.E Sn1.IC~ 1.iP;1'f APPLI°`: ONLY iP <= lE1-Yit, I4-HR i'P:'CrP F:YE;NT IS CIAI`:t:C. IE' CLA1:1 APP`tnv=D IIY <br />.;,C1, 'f5~ f, fHON LI!1IT5 WILL NOT HF. Ai]!'LIL:[. '"0 REP'7hTLD ;iEaS(IL•E:MENT5--.Sc= I.i'.1~, I]: U ANU I.F.ID, PG b. <br />