Laserfiche WebLink
rawMITT[[ NwMCIAVORrs9 llnduJr <br />F~rJlry Nnnr/LPr[Ibn 11 dl/INrnr/ <br />ADOR[0~2~~~I Y~~_--___--._-_._- <br />---~J~.1~E'~ ------. _~LLnnl- - <br />~wcalTr --------------- <br />LOCATION _____ _ _ <br />%TP/1 • Il 4' i L'T 1 _ TCU "• '19 OU G•: r h^11 P <br />DISCHARGE MONITORING REPORT NISINI <br />11 l6/ I ] I V <br />~_TI_S~f~l ~ .~L N,,...L. <br />PERMIT NUMrIER <br />MONITORING PERIOD <br />Y[AR MO OAV YEAR MO OAY <br />FROM -TT, ~ Tp • <br />r.'B JL IJJ.Jb /11 JU 06111 C.9JOr lin 11 <br />I'i l tl':'? f'onn Approved <br />(gl!'I l 'I c) -• pta@ [no. zaao oooa <br />F- F? 1+.1 L E%plres 9-J11-91 <br />AC'!?"'. %L'T r°STI v': f'If Jl r1A <br />..•;. 'i f? hT~i;: !111 nr;? <br />.NOTE: Read inltluctiont befor( completing this lorm. <br /> IJ Card Only) QUANTITY OR LOADING 11 r'PrJ !)nly) OU ALITY OR CONCENTRATION 1 <br />PARAM[T[R 116-SJI ISb61) IJ817) 116JJ) (Skill NO. <br />E% rw[oo iNC. SAMPLE <br />TYP[ <br />IJ7~17) AVERAGE MA%IMUM UNITE MINIMUM AVERAGE MA%IMUM UNITS <br />M17Jdl Nu •519 <br />IM1JAVI <br />IM1V np <br />_- <br />P/P Sf AT.i [. II ". II( A~II SAMPLE ..•'[':t C:: ',: L'.: i:: ~ ( ) ': (::::= ( 7~) <br />CLRI <br />ODAf' :f+IA MEABUREMENT <br /> <br />-ff <br />I .A~Jn. L ~ Il PERMIT ~ f,:'v'>'r'fii ln{/ 'v>r~~f='r~ ^r r <br />•'TR .'POP P~' r' <br />";'•'•'^' ~T ~~ <br />,HF PORT <br />IP. S=") <br />•TRLT <br />RA9 <br />I'F!'LUF:`-T 09755 9A1.1' REOUIRfiM ENT r:~- =~?1(IS flP pf/`r ND _ --- <br /> <br />F/t JYAT E' ^~?IR L1:II SAMPLE iP'::~•r •. •- ( ) ^••.. / <br />( n1) <br />; <br />S IRF. PIIPL .`; P^,0~!f f. 1 MEABUREMENT <br />. <br />T~:'I(~ ] ^ ^ PERMIT ~##### .~.:Yrf:[ .. li,'PIJfiT ')'~~~'~= NF.POIIT t•"=•) <br />' tT`tLY .RAH <br />~FF'LII:'~T ;"7„ 4'11.111 RHOUIR EM HNT -- _-- '.:rl '.L'SAf1F' ~II':~SA"n :•q t= - _ _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREM ENT . <br /> BANPLE <br /> MEABUREMENT <br /> PERMIT ' <br /> REOUIREM ENT <br /> 9AMPLE <br /> MEASUREMENT <br /> PERMIT .. „ <br /> RCgUIR EM lNT ~. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . <br /> <br />REOUIR [M EMT <br /> <br />s .. <br />" <br /> BANPLE <br /> MEASUREMENT _ <br /> <br />PERMIT' .. ... <br />~ ~~~ <br /> 'REOUIREM ENT ~ ~ ~ . <br />HAM!/TITLE PRINCIPAL [%[C UTIVE OFFICER \ CIRNn unOER RMALIY N LAW TNAI I HAV[ rCR50NAUr [f AMmIO <br />ANO AM IAMILMR WITN 1Nf M[ORMAiION SUBYHI[O N[PFIN AMO I.LS[O TELEPHONE D A T E <br />--- -~ -- <br /> I <br />f <br />W <br />^.- <br />~j~ <br />Y~l <br />/ OH MY INOVIRY OF iNpB[ rNd Vrq MLS IMY[d Ai[LY R[S <br />ONSIRI[ <br />( <br />OBTAINING IHE rNFOIIYATIO.Y 1 B[LR V[ IH[ $V BMITI[O IN[L1RYA\ION ~ / <br />W <br />~ <br />~ . <br />L/-~ <br />/ <br />/ <br />/ <br />' <br />\ IS Tg11F ACCVRIIL 1MD COMRFI[ I AM AWARL 1NAT TNf R[ AR[ SIG <br />NI(I('ANI PLNAI TI[5 !ON SIIIWIT IIMf IAI h[ INI pIM1110N MII IIOINI: e <br />r <br />/^ ~ 0' ~r - <br />/may/ <br />~//(U <br />y ,I <br />~{ <br />~ <br />~ <br />~' <br />~ <br />\.'11~ TMI PIItiGIHq IIY OL IIM[ AM(1 rMV gF.IINMLMI S[[ IB USC 1 Idll FNO RINCIP <br />L E%EC UTIVE <br />SI ~ <br />J <br />7Y <br />~ <br />~ <br />~ <br />{/~ I <br />/ ~ <br />U <br />/ fI V ~ <br />11uSC 1x119 rY•n•ler~- unA.. rM+ namb. n.n. rnrluAr lrn.~• uP I•• )ruu CNATU OF P <br />A _ <br />- <br />i <br />/ - <br />. <br /> e,. <br />, <br />A <br />nn.l <br />: ..•..i <br />e <br />^nm.A A <br />• A ^l• <br /> TYP[D OR PRINTED . <br />, <br />n.n <br />, <br />. <br />... <br />n..n.nm•unr„n~rn~n••••• <br />~ OFFICER OR AUTHORIZED AGENT QQE NUMBER YEAR MO <br />COMMENT ANV EAYLILNI1T1Vn VF ANY VIVLI111Vrv5 In.%rN'nrr rrn uuur urn..... nr..l <br />:~', P1F:T T•~ ^T- ).~~[..r. f.l)n I`F:T4TLc Ilf' T'i`-T +'N(I(':pUq}, i{:1.1.+.T ol::-pl.". .)~. 1.~(. T. .•i T.,.,.r• Iln:~ ..~., <br />~r,.+JBTALIT' T';f ("IIY ~"n"C f'ITIIpR-T~-[Y-~4'I~)~s A•c Nnl t't I'1•t r!w AND 4~T !'\'-1• tr-g T..: :"Ir R'T"T Tr~~.. -..,1~.. ..1. ;..1 _\ .~„[-. <br />Iw rL cES [4A w 10 wmc51 Ywr nor o[ uscD I c[ or <br />EP For (RSV: 9-r3H) PrsvlGUS RdIh ) m ~~ s[( 6d. ~' ~--n~~~~ Y~~~ ~-J----- <br />