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I <br />I <br />I P[RMITTE[ MAY[/ADDR[EE (Induct[ <br />F~cElry HBlne/Laswbn IJdi/JnenV <br />YAYR O L A i V 10 f f'I ( 1 1 1 <br />;, <br />NwnowwL FOUDTAxT OncNwwcc cuYlwAnDN•V\T[M lNPDE51 <br />DISCHARGE MONITORING REPORT /OMRI <br />/1.161 /l1~/9/ rI.'. <br />Fnrm ADDrnuwd <br />.. <br />woDREn 1 il, ~J~'~-^____T___ . <br />.. ~ .~ (:~l'i: :: rl4) "r.UNQ iNo. Y040-0004 <br />___~~_L ~~1 PERMIT NUMBER on[Nwwca NUr[u <br />_--~~,~~i_~/- r - t.).}. E%pl[es 9.30.91 <br />~ <br />-- <br />- <br />~w I'!`.I'!In:"~. '. '1 'l'FI!i/ ~p.Gr: C3ECK <br />--- <br />- <br />~~ <br />~ MO NITO RING PERI OD <br />PACIUTI <br />~ Y <br />-__~T ___ <br />_ <br />YLwR Mo DwY YEww YD Dw <br />To , <br />O /AR CIRf/~T FRDM ,. <br />LoewrwY Gd <br />; <br />~ h <br />' <br />:?: _ <br />ar <br />t: <br />1.1 <br />1 L <br />. <br />. <br />~L[_- <br />_lL_------ <br />~ :• <br />. <br />q(. ulSCRI,HI:E .. <br />/ f ~ ! •f"T"^IV^"-~'~ i' 1: 1 ' 1 ~•' "~ " !7071/ /77~IJ/ (767s/ (l ~ I !7 ~ 1 / <br />I NOTE: fled IniLNCtbM hetOr j PtEttnE thiB torlR. <br /> (J Card OBI[) QUANTITY OR LOADING 11 Card On111 QUALITY OR CONCENTRATION Fw [OUEMCY <br />EAMPLE <br />-ARAM[T[R (M-J!) 171611 (JB~FJ) 1[BJJI (JI-0IJ NO. <br />F <br />% OF TYP[ <br />(JI-J7) ' wMALr•1• <br /> AVERAGE MALIY UM UNITE MINIMUM AVERAGE YA%IM UM UNITE <br />BI-0J) <br />I6Idtl1 <br />169~IU1 <br /> <br /> MLA[UREMENT <br /> <br />x./11 ~.( i (1 n <br />~ PERMIT ~~,`K <br />:"~Ol tBii lG#1;< <br /> <br />~.. <br />~>:'1~{!T'j{: iA.~ <br />;:4 i- <br />.o-: <br />~ <br />+i <br />4 <br />~~#{[4':ti.: [,[ <br />3 ~+ <br />.. ..:......:~ <br />~~I <br />R.P <br />Y <br />K~ ~e <br />~+ <br /> <br />L"}'I.IIt't.'. ~li(IS~~ YRr.II' REQUIREY ENT <br />.... - ~~.., <br />.....:.--:.... .. " <br />..: <br />Jr.:rlr.: . <br />. <br />. <br />, <br />,a . A V <br /> <br /> <br />.... <br />~'. ,.:J'.':ri° <br /> <br /> <br /> <br />,"s.. . <br />} <br /> <br /> <br />.~~,I a.R~ <br />.1 1.1 /1 :! • (; ~} 4 t. EAMPLE • i U '.;::;L i:'v :; J ~ ) 4 :;L ~. (..;::; ~ J J) ' <br />b `)J} t('ILL YEAEUREYENT <br />L LJ `. 31) i (.' .I PERM tT'~x< <br />RLOVIR[M ENT "'f" L:1R# iY ~A[Y >ig <br />~ - ~ <br />'~ <br />~ .~.. , '~frISO #iTC~{I " <br /> <br />~ ::C { S7~L`!+Y # =: <br /> <br />:~. <br />~' <br />' <br />~ ~ ~~~° ~ ~ <br /> <br />~. <br />a <br />f <br />~' <br />'ro s,~:Y< ;. <br /> <br />~1. ~ <br /> <br /> <br />CL <: <br /> <br />a <br />~ <br />I <br />hF}I I..hl r. n;l~, .`, Vn LIZ' . <br />..,:.... •~::.~,. ..., - <br />_ ..:,p,.;. ~:; .:~$z <br />.. `.. • <br />,_~ .. <br />a <br />..~ <br />.. . <br />. , <br />-'a Y , . <br />:I'J{.]Il:i[ 1mT L: !..t .. EAMPLE Li :i [.:,: (: t. 41L{:; {.::: ~ ) :: {: ;1 {1 ;u,: :: 1. L}'Y:::~ ~ 15) <br /> MEASUREMENT <br />G~~ti4~ 1 G 0 PEIIYIT...'_ <br />~ ~~: ~saacaa.:,~ <br />. <br />, <br />~ <br />~ ''~a.a~#a~=~ ;~._.°6 6+k.s`~~ <br />^ ~:~` ,.~~ 1, ~~~;"~ ~~a:, <br /> R[OUIR[Y ENT <br /> <br />~ . <br />. <br />r_:. ~. <br />.. <br />, <br />. ~,,, ,.:r.. ~ S, - <br />.~ sPg i <br />L is :. R)t I~ ~ I }'SI EAMPLE 11 .: :.',: L. 1: :•; <br />l:.:,: ~:i ~ ) . ...: 1. 4': 4:.':;..,.':' ~ ly) <br />} 141.L II }. 11 1 11 ~'; is 1'. V M h~ ° f YLAEUREM ENT <br />I. J11 JEl t !) J IERY IT. ~.:. <br />... 'e'=P.<;t:##>{LVI~ L\FF ~I "~6'iQ 1 <br /> <br />~ •::C:: ^"~'°rCi1t /f ld,#i},~ <br /> <br />.y <br />„m~14.~[l't #[t j( <br />~ .ea.'~.Y:;' :;! <br /> <br /> <br />~ ':xre.. ~' 'i: <br />,. <br /> <br />- R[GUIR[M ENT. ""' ':. "I$w yxg. <br />' <br /> <br />q,. <br />(. <br />P <br /> <br />.: ... <br />. <br />e,:- <br />~iY <br /> <br /> <br />. <br />. <br /> <br /> <br />' <br /> <br /> <br />7 <br /> <br />111' L :~' ti 7 111 ,: s. <br />T e. <br />•. <br />~".. .. - <br />e,_ a~ <br />1IJia[ <br />s. .: <br />At'jw' <br />. „~ <br />r <br />~ . <br />r,. F (. <br />1 .d)L, '. EAYPL[ `, r'.:Gi: {: :.?.: ~:': ( ) .- ~.c. ( 19 <br />) <br />/ <br />}. ~. M[AEUREY[NT .1 ~~ ' <br />) <br />1i <br /> <br />l 1'~ 4 L1 : CJ ~1 ra., <br />~~P[RNIT <br />" G #F.t,'r`TF 4l?, <br />/'~,$~{L 3'FYfi ~. <br /> <br />.. . <br />1 <br />.. <br />~#4YrL[' iY Si'.~1::'~' <br />~ • Q, ... °..x <br />i~ ~;a,~. :.: 'xg <br />?t <br />aKC . S!. <br />~.x $... ,i <br /> <br /> <br />, <br />- <br />1. r' L~ 1 II !" 1 L. p7 r , •' u P IJI I . <br />% .~.~' ~,i~.r, : ~: ..3 :xs. •;~, ,« <br />~,,. <br />rLU~[ ill rr.isrllTT 1,Ij EAMPLE ~ (: S) ~•.. VL.V~:4 >r~l:'1;11LY / ) <br />'1 .1:' L ~I II ~ . i ~ ~ 1' 1 i' I I LI •~ MEAEU REYEMT <br /> <br />! 11.;`_:1 I }, ( ....„x w .. <br />~KRY IT .. <br />REOVIR[YERY; „ <br />~1 ~.~yls T'~% <br />QF'~1. ()~N AL's <br />~P.p,', IGp#?(t ;> <br />.:.. e'#O~FtYL:(: t <br />~ <br />~' <br />'cXs .h la ~''t fi. ~'„1 <br />•lJCt .. <br />~~ <br />}.''h'1.111:Ili f.F')" VR1.!li r w• I r..~,,;'•. `x. <br />°" ..~.A !It ^'_'• <br />::Ui.I UCI a'I '.L EAMPLE 1 ;. {. ;: 1;:;:.:::~~ ( ) .:::.,: :<C ( .14) <br /> <br />I.L::ti~i:.Y~.. MLASUREM[NT <br /> <br />7J2yS (. 1' <br />PMY1T. c:. <br />X.44,. tl Yj.~lrf45i, <br />'~~= .` <br />•'°'. >,Y la4Y~rt#_ <br />::GI. <br />,~~iL°~il~aa~ <br /> <br />. <br />, <br />< <br />y`` ~: <br /> <br />~~P'f2~0~7~J1~ ~: <br />~ <br />% <br /> <br />"REPO <br />°R `:. <br />°g <br />°.' d.: <br />.. . <br />REOU1ReNeNr <br />~.'~'~ <br />.:~Lu <br />., <br />... <br /> <br />w. ,. <br />_....: <br /> <br /> <br />~~ <br />NAY!/TITLE -R INCI-AL LLECUTIV[ OFFICER I c[wTPV 11ND[R P[NwLly M ur THAT . NAY[ F[RM]NALLr nAM1w[o <br />1Y 11YILIAR LNTN TN[ IN[OPM <br />LIION $UEWTT[D N[I1[IN AMO pI <br />AN <br />S[D T[L[-HOH[ PAT [ <br />. <br />. <br />° <br />I `tll CN YY INQUIRY OF TNO•F INGVIDI/ALS IYY[OIAT[LY R[SPOM~IEL[ [OR <br />1' ~" T OBTJIM WG TN[ MFOIIYwTpA ~ B[U[V[ IN[ SUBMITI[D IMORMJOON <br />1./i f ~/~ <br />~' l , <br />, l _ /rl <br />// <br />/~ <br />~ <br />/) <br />~ <br />IS TMI[ dCCUR.LT[ I,NO CCMR[l[ 11Y 1WaR[ TN1I TM[R[ aRf 514 r <br />~_ <br />/•F-'•° <br />W WX <br />_ NRICINI TNILTRS [OI1 SVCYITTIMG I1L5[ INIORY111d. NCLUdMG <br />V <br />[NI <br />C [ 1 <br />1 ~ ( <br />r • <br />~/ <br />CJ~ / ZL <br />001 aNO <br />51bLnV OF fMC I1MD IM <br />N50NM <br />HC IB VS <br />TN! PO <br />' I 1 1,1 .r1 11 ~ ". ~' 11 / <br />.u <br />llu m. <br />SC 11]19 1K <br />Mn 1b <br />mmb • urldr Lv. <br />e <br />ll <br />l <br />EIONATUR OF PRINCIPAL E%ECUTIVE /t' / ~.- L <br />~ <br />r <br />yr <br />. <br />a <br />g <br />ly. u <br />TYPED OR PRINTED a.d.,•wr+1...iw.•.e•1•••u..••.1 ,./1r1u..n[n~.n1A. •wdi•w... OFFICER OR AUTHORIZED AGENT A NUYEER Y[AR YO pAY <br />COYM[HT AND EEPLANATION OF ANY VIOLATIONS IRrlrrrnrv nll VlmrNlnrnb ngrl <br /> <br />,. , <br />1".1~. ., ..=--11::11:.1.1 P/, !. .. :: ~i l 1. 1.1111. ~: ;•I:'~i i.IMI... it i'i.f i~: : I~gLY :F' (= 1(-'!i"[ T4-I!H P~LD f.YFNT 1:°_ <br />~. I .., i ..o .,.. :.r r. ~ .1 I r , 1 I ! . 1 , l , ~ I , ..,. .. 11 ..1 . .1 : nrs--~: rr <br />