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I er^•, wvm Rum r/rvnrl <br />NamE pk.~LCOA.LSO_(B~~SLNE)_--- <br />ADDRESS ~ ~ ~ ~r~~ ~~~ _ _ _ _ _ _ _ _ _ <br />--- eLAGST.A.F~--- -- --iZ--flb0..1L- <br />FACILITY -----------_...._--- <br />LCCATIO'J- -_ - -_ _- - -_ _-- - -_-- _-_- --_ <br />rmu. no.vu rc Tr;•v CUCnll DDOCTnP NT <br />DISCM ONITORINO REPORT (D.5lRl <br />/z~ !/~-/v/ P - PIBAL <br /> STOR?VATER DISr'I!ARr,c <br />PERMIT NUMBER DISCHAPGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO h I NO R n 11T 4:i <br />nazu rzzz.u lz<~zv rze.zn nxaW nn.rn NOTE: Read inslruclions belore comDletino This lorm. <br /> (i C'Rrd Onl/y OUAN TITV OR LOADING NCard Onlyl QUALITY OR CONCEN TRAiION <br />NO <br />rnF <br />IICr <br />U <br />PARAM EiER /Jb.7Jl p1-b 11 /J8JJ1 N6~JJl /Jab// <br />E% O <br />F SAMPIE <br />TYPE <br />/J ~~~~/ AVERAGE MA%IMUM UNITS MINIIdUM AVERAGE MA%IMUTA UNITS A°AL. 515 <br /> rb. 63 YJ Avl l5P:01 <br />ii SAMPLE #=k#i=r-'t. r~v`r## vY'.k### <br /> I.fEA$UREMENi <br />JJID~ 'E p 0 PERMIT ###### ~r`~r=}##~f ',~''F# 6.5 ##t##',Y' g.~ YCE/ RAD <br />FLA°NT CROSS v.+LUF. °`°°""'""' aY# MIA ~On t1AdIn0!1 SU n')BT8 <br />'Oi.IDS, TOTAL SAMPLE #'r':+'v# '~##;#+ ###~#~ #t#### <br />' P D iI D E D MEASUREMENT <br />~JJ/J 1 V V L`_Y L.'#AA <br />- Ai}S-`'.4 i:# ~ •_ _•A~A .LA Y•~•Yr~"i--~ <br />REP^v^uT ~ <br />ACF.i <br />:t Jio <br />v r 9 REOUIREM ENi ,/..~~,, .~ ~ ( N <br />ULI05 <br />SF.T.TL~ '13LE SAMPLE #~#~L•# ###### ..####~,. rr~r## <br />~ MEASUREMENT <br />OS~S 1 D Q PER!.11i #####+* ###Y#•t ~r ~~##r# +~~#### D15 NC E/ RAD <br /> REQUIRE MENi ~., ,', `,x <br /> <br />r <br />V? <br />IL AhD CREA52 SAMPLE ####r# ~##### r###+~# ##v$#."r <br />,RAV 4{~Tr{ <br />REO}l E%TR- MEASUREMENT <br /> <br />` <br />0556 1 rJ D PERMIT #YV-'nYY ##Y#Y# ~r•! #f#YY'f ##YYr# 10 NCE/ RAD <br /> REOUIREM EN7 <br />RD;J, TOTAL SAMPLE r###<< #####Y ###:";. rr~#'## <br />(AS FF,) MEASUREMENT <br /> <br />O1G45 1 V O PERMIT ###~^.~.# ####t# '~k+`r ###, ,, ###.~+# REPORT BCE/ F <br />AR <br /> REQUIREMENT . <br />^ C <br />~ U <br />LOiI, IN CO!4DnIT 03 SAIAPLE ##L`:## ~##:`•:'= #i~~ww <br />-?U TREATP,J:RT PLRRT MEASUREMENT NO DI CHARGE <br />I X50 1 0 O PERMIT <br />REQ <br />IREME <br />T REPORT REPORT :#=### ###### #+.~## r,. <br />EtRLi -I <br />NST.+K I <br />c U <br />N <br />TfrTAL <br />SOLIDS SAMPLE '~~$#v# ##i### #~v.'r#$ v4``#~#i- 1 <br />. MEASUREMENT <br />GISSOL7ED <br /> <br />7D2~5 1 0 O PERMIT ###3## ###### ~r ;##:## ###### REPORT T3Li RAD <br />D a REQUIREMENT F „ <br />'!A"E, ~.~~E ('^~ ~~ ~C% ~~. ~~ ~~ ER " <br />AND AM FAMILIAR WITH ~i SHE INFORMATION SUBMIT TE -RSONAU. EnAM1nrvEU <br />D HERBN <br />ANp BASED TELEPHONE DALE <br /> <br />Brian P. Dunfee, Manager ; <br />ON IAY INQUIRY OF THOSE INDIVIDUALS IMMEpIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORM AiION <br />~ <br /> <br />En <br />iron <br />l St <br />di <br />t IS TRUE. AOCURAiE AND GOLJPLETF. I AM AWARE THAT THERE ARE SIG <br />NIFIf <br />ANT PENALTIES FQR SUBMITTI <br />G F <br />wFO <br />n+ [ Z( <br />v <br />men <br />u <br />a <br />es . <br />ALSE <br />N <br />a <br />AnoN, wcLUDINO <br />T <br />E P <br />IBI <br />NV OF FI <br />J 602 774 O L5 <br /> H <br />L <br />NE ANO IL <br />OSS <br />PRISONMENT. SEE IB U.SC 4 (DUI AND <br />IJ19 <br />P <br />l <br />JJ <br />S <br />C SIGNATURE OF PRINCIPAL E% UTIVE -5253 90 1 <br /> U <br />. <br />mu <br />nrs untlrr rhrv rmmra mu. mduJr Jrrrr. up m 110,(rn <br />/ <br />l AREA <br />TYPED OR PRnJ1Ep onerrr mv.rmum rmvrrmnmrnr o/l,rr.rrnamonrn. unc f/rn.,.l OFFICER OR AUTHORIZED AGENT NUMBER YEAR Mo DAr <br /> CODE <br />I,UMMtrv 1 nrvU t%YLANAI IVr! OF ANT VIVLA I IVNS /RffPrMfP all nlln[hmenli hrref <br />IF HO DISC{iARG= OCCU'S REPORT °`10 DISC.°.ARGE^. OILS AND r,REASF; SEE FOOTNOTE F/. <br />EPA Form 932a11RBV.9-BBJ P/BVlOUS edI!lODS may DB USed. (REPLACES EPA FORM T~~O WHICH MAY NOT BE U$EO.) PAGE OF <br />D <br />V <br />I <br />O <br />