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mu I[C NAMEIADD 5/In.6Jr NATIONAL POLLUTANT ARGE ELIMINATIDN SYSTEM /NPUES/ • <br />hnl,I/n'umr/C.YAI On p DISCHAR ITORING REPORT/OM1/H/ <br />NAME_~ n ~..S7~Sr~L~.L~~~Fi.1 --_ /l~lb/ 11719/ F - FIVAL <br />ADDRESS ~~_~ [ F. 000000213 001 A STORRNATER, SPOIL SPRG t: 1I9E <br />__--r..A~"a..I AFB------~~OG DDS - PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY <br />-------------------- YEAR MO DAY YEAR M DAY <br />LOCATION FROM TO <br />____ nlaoR rNTR:3 <br />_-__ <br />- <br />_ _ <br />-__ <br />_ <br />_ <br />ATTR: UEeNIS STE9 EN SON PR45IDEdT /lal// /ua3/ Il+-7J/ R6 vl R8-79/ /JP31/ NOTE: Read instructions belore Completing this Corm. <br /> /J Cab Only) QUANTITY OR LOADING I+Card Only) QUALITY OR CONCENTRATION <br />NO. <br />FRE OUENCY <br />SAMPLE <br />vARpMETER ps•Jl/ pd-bl) /384J/ /lb~Jl/ /JI-b// E% DF TYPE <br />IJ".J]) AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS <br />Ibl~bJ ANAL V515 <br />Ibd~b9/ <br />I69~701 <br />H SAMPLE $r#$$$ #$$#$'+~" <br />7 <br />10 $$##=Sr p r~ <br />8.02 <br />O <br />~/~ /~ o <br />GRAB <br /> MEASUREMENT . <br />J )1100 1 0 O PERMn ######' ###### #r# 6.5 +'~_#~' 9.0 EF.RL[ RAB <br />E?FLUFFY G30SS 9ALUr REQUIREMENT `;:r#$ 2fINil1017 17AYIn0!7 5U <br />LIDS, TOTAL SAMPLE #$###v #$$v vi' 3#vv ±$ 1 <br />1 <br />30 pp <br />IO.DD <br />O <br />~/3D I~ff~TII11 [[]] <br />GRlIU <br />.~SPEYDED MEASUREMENT . <br />nn <br />'`0530 1 :I D PERMIT ######" #~##$#. 'v'-k+'~i~ #+~#'~## 35 -t <br />!D NCE/ RAB <br />R R REQUIREMENT <br />$$$A <br />OLIDS, SETTL3AHLE SAMPLE ##$$## ###$#$ ##t$#$ $v#$## <br /> ME45UREMENT ~~ <br />J0545 O 0 D PERMIT ######- ###### r;n# ###### $#I~$## OPTIONAL NCE/ EAH <br />R ~ REQUIREMENT $~A# m <br />IL AND GR4A54 SAMPLE +'~'~$+## #$$$:$ +~$i::#$ ~.#$r$$ <br /> <br />F <br />R~O <br />N EYTF-GP.A <br />[ NETS MEASUREMENT -- <br />n <br />c <br />f <br />J0555 1 J J PERMIT ##$### #•~#### #vf: #$#$#+~ v#$### ID uEHL[ RAB <br />P REOUIREM ENT $$+# r <br />IF{fl }1, TOTAL SAMPLE <br />MEaSUREIAENT ~##$$# #$##•f$ +~r$+~m-ten <br />D <br />28 <br />37 <br />D <br />O <br />~/3O /~rt~D <br />GRAB <br />(AS F.m.' • . <br />O1u45 1 0 ~ PERMIT $#$### ###### Y$Y #,#### 3.5 7.0' NCE/ RAB <br />T ~ <br />0 REOUIREMENf ir$`# <br />~'O., IN CONDUIT OR SAMPLE <br />MEA <br />UREM <br />T <br />463 <br />0 <br />073 <br />1 =$=$Yr -~#$#- #$r~~Yr <br />0 <br />1/7 <br />INSTA <br />u TRE:1T'1ENT eLar S <br />EN . . <br /> <br />50/)57 1 0 0 REPORT REPORT #3###$ ;.##### A y <br />YY$YYY ~$r EERL[ tlSTAN <br />R REOUIREMEHi _ #r <br />SOLIDS, TCT.1L SAMPLE <br />M <br />T #$ $Y <br />Yr w <br />#$$Y'lr <br />=~rr$$Y <br />Y#mr$$ <br />2928 <br />00 <br />O <br />1/3D <br />URAU <br />CISSOL9ED EASUREMEN . <br /> <br />70295 1 0 0 PERIAIT ##$### ##$##L` ;-F$ #####$ #$##$# REPORT TRLY RAB <br />C ~ REOUIREM ENT $1, AA Mr <br />NAA!E/TI7 LE PRINCIPAL E%ECUi1VE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE P <br />AND AM FAMILIAR WITH THE INFORMATION SUBMITTE ERSONALLY EXAMINED <br />D HEREIN; AND BASED TELEPHONE DATE <br />Dunfee <br />Drian P ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />TAINI <br />FORMAT <br />G THE I <br />N I <br />EVE T <br />BM <br />TED <br />OR <br />O <br />S ^ ~ <br />. <br /> <br />M N <br />N <br />IO <br />BELI <br />HE <br />U <br />IT <br />INF <br />MATION <br />B <br />IS TRUE. ACCURATE ANp COMPLETE. 1 AM AWARE 1HAT THERE ARE $IO~ /1[_/ <br />anager <br />Environmental Studies NIF ICA Ni PENALTIES FOR SUBMITTING FALSE IIFORMATION, INCLUDING <br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S.C. 6 1001 AND <br />JJ U S <br />1 1Jlp IPrnahia undo lAnr uarmrs may mrludr ].nrz u <br />C <br />to J19 <br />q%I <br />SIGNATURE OF PRINCIPAL EX UTIVE <br />6D2 774-5253 <br />9D -1 <br />0/ ~]C <br />LJ <br /> <br />TvPED OR PRINTED . <br />. <br />. <br />0 <br />and or marlmum lmpruonmrnloJb[IwrrnbmonrNand Jyrarz./ <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> coo <br />a <br />J <br />COMMENT AND E%PLAIV,AI IVN yr PHT vIULP nvrva/ne/rrenn mlvuarnmrnN ncre/ <br />OIL AND GREAS~; SEF. FOOTNOTE F/. O--tlOST REPORT IF EIEhPTI0N5 CLAIt1ED. TSS I'10SR BE RE°09TED AT 9LL <br />TIAeS. <br />SiEEJ PIlVIOI/S Bd%IIO/1J m,y DI UaBd. (REPLACES EPA FORM T~dO WHICH MAY NOT BE USED.I PAGE OF <br />00011 /1nn5~o_1~na T ~, <br />