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Ise nwsTL/ADDRLEB (JnE(Ydf <br />fMley NME/Lonfbn 1/dIJJPEnrJ <br />~__~~l-_`I_______ ~ __• _-_ <br />-weluTT <br />LOCATION <br />y ----- j ~ -,~ ------ <br />MATIONpL POILUTn MT OIaCNPgGE [LIMINATIOM aTaT[M (NPDESI <br />DISCHARGE MONITORING REPORT /OMR! <br />116 17-19 <br />r <br />( /• : 1. 'I ? 1 „ I ; <br />PERMIT NVMaIER olacx Awac xVMacB <br />MONITORING PERIOD <br />YEww Mo DpY YewR MD DAY. <br />FROM ~ v I TO ,~ <br />110~I1/ /1113) 111~IJ1 /16- 7/ 118191 10- 1/ <br />I ; ~ <br />Form ApProyed. <br />~ ' (~ ' '' ' n f OMB No: 2040-0004. <br />-r' ? `: A LApproval expires 6-30-91. <br />;iil'.[ fC?IC~ f,SC'( "C G~:t 1'. 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L L If ~i C L ~~ .-. ~ .l ~' \ I (~ <br />/ ~ ''I v <br />, <br />' BAMPLE . <br />~ ~ <br />r (~ 0 [, MEABUREM ENT <br />) <br />~) 1 <br />) m «e <br /> <br />F <br />E' <br />i Y )T'Eµ :n '~w Y'64' <br />R 9: <br />'~ <br />' )- ~ St A <br />T"'~6 <br />~ Y,&"r~3a. L'& P~ <br />~ . ~p <br />4 <br />~` •'T^ ~@ <br />~ tp p} <br />`8T 4f <br />.. .. <br />. R <br />11 <br />;.: <br />k <br />-RBQUIREM ENT 4„ <br />~~ v ,z v <br />~ .,. y <br />~ a -. <br />` <br />` <br />4 ~ <br />3{ - <br />• $ <br />.. <br />a >3 <br />x ..a <br />ffi <br />n <br />a <br />' <br />' w <br />' a a ~ <br />g -3 38ID <br />xb.¢dP <br />45 <br />i ~, 8 <br />g g. <br />."tiY <br />" <br />Xa .re <br />a <br />cem .~~~ ~. <br /> <br />f Il : 'v ' I , <br />xF'~-~rn.a~ a ,g <br />~°=^~. •e,.Q»a. < <br />°~ <br />N <br />°~,U..r #~.n~a4 ., ) T L <br />4 <br />a <br />m <br />.®wa~ ea, "'§ a ~ ~ L3 d' <br />a ~ >g , <br />, <br />a <.e»a'a~w a' »' e ~ ~ <br />d. '~.~ : <br />„~~ <br /> BAMPLE <br /> MEASUREMENT <br /> <br /> <br />E <br />~~ ER tY <br />M V <br />` <br />a.grv.+tm e>aa Ga ~q <br />a® <p'tl <br />`~ <br /> <br />b <br /><9TH b RP aF <br /> <br />_ <br />• <br />~[ T Y ~g° <br />ine ~~x~a ~n m®8 <br />eyg.a <br />- ~ 6 ~ <br />a ~a*c <br /> <br />' <br /> p <br />4 <br />4Pl7 <br />REF141REM Aan w <br />, <br />.}{s ~ <br />q <br />a <br />~4n~ <br />x g <br />•aY ab~a <br />=~'•P xca~.~ sx z~»w <br />~ p« <br />x'e As <br />~ g ~. <br />~ <br /> . <br />a <br />A4'.a wd'&d'na <br />PF p®Ybs pKx . <br />(n4ai.$p.e^9• <br />T.u mi°FXr p <br />.p~'9 4~SY>, x3i n,ry <br />-$.. <br />.A:>mn~~ <br />e > <br />e~ ~~''~ <br /> BAMPLE <br /> MEA6UREMENT <br /> e.r,ba0 ¢ u i4 vW Fo-.an a..: ng <br />Eg <br />rn ID~ <br />' kr'ek gB a@ ,aF, <br />s~ <br />S~ °~58 ® axffiA <br />~ <br />T b ~ PV 0g~$~ g $a"Aag qy~g~ <br />A ~ °x`c <br />II <br />ffi $'S"•`4 A~•i~ <br />V <br />6 ~~ ~~ <br />R <br /> RlcQV RE µ.ICNT d <br />a <br />~ <br />" ` <br />A <br />nxex¢.b d &6g' <br />M <br />° 8 ,>£ 3 <br />~~~ 845 bw g ~~ R <br />" ~ i, c , <br />@ R <br />a 1A <br />~ ~WK^""_ 9u <br />J <br />4 <br /> .X1 xd /ab. k'a° ~ xed «k.e <br />° <br />r . <br />, <br />2.axaanR 8Fx a'e. <br />~ R9/n-: xn, gaBY <br />~ Y6~¢'6'A',`e'f'kpa#~$'&. i .~." <br />. `lea •`A.'.xa ~ <br />NAM[/TITLE PRINCIPAL E%[C UTIVC OFFICER Or LAw iNwi I NAV[ <br />PEp60NALLr [%AMINED <br />I CEgilFr UNDER PENALTY <br />•NO AM FIIMILMp WITH THE INFORMw TION SUBMITTED NEBCIN AMD BASCD ~ <br />~ <br />~'~ TELEPHONE D A T E <br /> p1 MV IMWIRY OF TNO$E INpVIDUIILS IMMEdwTELY RCSIdT51BLC FOII ' <br />' <br /> OBTAWVIG ixt 1NFOIIMATgl1 I BELrtvE THE 6UBMRTED INlORMAnOn j <br />/ <br />G-, l <br />`1AJRK K~~/' r~ <br />DL F' I IS TRUE ACCURATE wND COM0.ETC I AM AWARE TxwT TNCRE wRE SIG <br />NIFICwNi PEMPLTIFS FOR SUBMITTING FALSE INFORMATION INCIUPNG ,~ '~~~ <br />( <br />S <br />ixE PO^SIBILITY OF FINE AND IMPR50NMENi S[E IB VSC 1 IOOI AND <br />~~~ a <br />~~ S /JV 9 <br /> <br />JJUSC 51)19 IPrnelnr. undo ]Arr trump. nRr nr(udr /mr. up m flnwxl SIGNATURE OF PRINCIPAL E%ECUTIVE / <br />TYP DOR PRINTED a.d..•ma.~InunlmPr.••,n~I.nr.,/Mru..nRn,.nrA.nnA i.ra•., OFFICER OR AUTHORIZED AGENT A '~ NUMBER YEAR MO DAY <br />COMMENT AND EEPLANATION OF ANY VIOLATION6 (Rrlnrnrr all Ruoanmenu nrrq <br />,IL~ _'i.. .:):.1. 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