|
PEwMIrrEE Nwl ,DDweeB (Include
<br />YP[tdlry Hnwe/LDC[, :dlJfere(%'-q~ ~I '
<br />AaFrC}.~~~~L1i YLI~1~ ~~L~____~__
<br />wDORBn~~~ 1~~ I; S,___
<br />-wourT_ _
<br />------------
<br />LOCATION
<br />A.['T_ti: P.ICifAED ATFINS~'1
<br />NwTIOMrIL POLLVT• 1lCnnwG[CLIMIN nTIOM /VyTCM (NPDESI
<br />DIBCNARt. IONITORINO REPORT /OMRI
<br />1'Ib l
<br /> ~
<br /> PERMIT NUMBER ~ RIycl.Awc[nvr E[w
<br /> MONITORING PERIOD
<br /> Y¢ww Mo Dwr reww Mo DwY
<br />FROM J (1 11 (.' ~ TO ') l,: r, q !)
<br /> l10~111 l11~13/ l11~231 /Ib'1 1 /1819/ I 11
<br />M I f:I) 4 Form ApproveB
<br />(S11 F'~Y.~ NV) ;1;OM99 No. 2040.0004
<br />F - FI !: A [. E%plree 9-30.91
<br />GJ~/II ~ Jt."\ I Yi..,,/(. /l'ua~ '~'~II . ~ k
<br />,NOTE: Raed instructions before c6'pletinp this form.
<br /> (3 Card ONy) DLIANTITY OR LOADING (I Card Only) QUALITY OR CONCENTRATION
<br />PARAM ET[R (1673) (Slfil) (38
<br />I7
<br />Ib
<br />S3
<br />H61 NO, FREQUENCY GAM PLE
<br /> -
<br />) (
<br />-.
<br />) (.
<br />) OF
<br />TYPE
<br />tj1.j)) E% ANAL Y615
<br /> AVERAGE MA%IMUM UNITE MINIMUM AVERAGE MA%IM UM UNITE 61dJ) (bld8l (69-70)
<br />OIL ANU i;H F.ASE SAMPLE rk r,: :k.T4,,, ( 9+J) I dGY,:::c r;,~'~:: C:::: r:;; ::~:; C+` ( ~ 1
<br />VISOAL MEASUREMENT ~ ~ ~
<br />81tC66 1 0 n ,e qp,...,'~.°
<br />ERMIT' xn
<br />9 'g~e~ Ak>~
<br />.o- sA ~ :nn~,.~,k~A~,~®
<br />`°¢„~
<br />' _
<br />:.:']-i ~,~ w:~g.
<br />°~i. fRLrY-: <
<br />w
<br />« P_sg~ , °
<br />Po &'°~~+r'~5 J}a« «- «,gm
<br />'mg „I~¢,°y'fYAi^ s
<br />s
<br />
<br />' ~~pe y
<br />€' ~
<br />i~
<br />~
<br />~'
<br />
<br />~
<br />~
<br />(:
<br />r P
<br />p r ~
<br />E
<br />FLUEN
<br />YO
<br />V R¢QirIR8M,H
<br />17 .g
<br />"
<br />me ~*e
<br />~
<br />" sear #a
<br />`
<br />' .
<br />~
<br />.ea
<br />.~vs'..«
<br />"s eWps m, '~xa «s
<br />a a®~
<br />x¢^as'
<br />ti
<br />n
<br />"
<br />"
<br />°
<br />' „"~
<br />x
<br />` e
<br />.,
<br />,n'a s e
<br />n
<br />..>
<br />.
<br />~s
<br />T ~i
<br />ALU: I
<br />n,
<br />n
<br />a~
<br />mom., ~f
<br />~
<br />, ~ _r ,
<br />~
<br />Po~„rb~'A'ma °,• m '8:a «°"<"a
<br />a~b ®
<br />.
<br />"°w
<br />«
<br />°«~
<br />"~ g
<br />~,°. %a:;°
<br /> SAMPLE
<br /> MEASUREMENT
<br /> I, r'°"PSt+iA~If°<.a q „m>°:
<br />:;;
<br />r
<br />p Poa °~q«e rab~ a°~,;;.ap-.p g„ nom. °e:
<br />e °~
<br />°`"">~~~ a,ae;Amgba~»
<br />` q.
<br />~ <,°;
<br /> =REQu1RF.M Br1Ta w
<br />'8'a $;
<br />a
<br />°a gf .
<br />' ...«
<br />Sxm
<br />A~~a
<br />°~ 8 ~~
<br />pa.&
<br />„„~~g
<br />r .
<br />,
<br />'~z
<br />~'ae
<br />.~~~a•;
<br />x~ Poe
<br />`a~<a°~n' `°.a. °'°Aa.;
<br /> •a'e <
<br />x~« a
<br />,«w
<br />~
<br />>a~g ^~'wg.„ .®A u
<br />.
<br />.~.
<br />a
<br />.p; 4m nV« °b;¢ ~<
<br />,
<br /><m
<br />o>Kw SR.s'mw~a< „
<br />~
<br />iap>tl"6Vnm:i~o-b °u' Y•>. ~` Axw
<br />
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ~-s~PERM LT°.. `az °^e~'cm °~.; r°a '»¢ ° ~• '^wo
<br />`
<br />a +¢'
<br />°~ »mc ~<w'" m&m z,y e~
<br />"sp
<br />«
<br />° °
<br />°~' ®®
<br />tl ~°
<br />g .8. p a.w
<br />~ "a
<br />:
<br />"
<br /> 'REQUIRIM El/T a<:~ w>
<br />e
<br />ez'
<br />~
<br />~ . m .
<br />M
<br />a
<br />«
<br />r
<br />` e
<br />o- e
<br />a «
<br />«»
<br />e .g
<br />~ ~ ;^
<br /> .
<br />g x# ° ~'am ~q ~'°
<br />.
<br />u~.p '"%.~n~°'~o-»~"«m;b~ ° °~a~'.a'°"<~m~.
<br />«e`a v°w`sx`0x~s.'°~'a`.m. ss`sa °
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ">.P¢RM1Y,'<° ~ s.„ =e00«"„
<br />g °'; °a se w; ~;.»«« n a'~~.m»'°a"x„
<br />° asap w:m
<br />~:'°.: ~:
<br />a a ...,°.'~n ~w «
<br />"
<br />p cae :°<m
<br />°
<br /> aREOgIREMEN,Ts «
<br />e ~a °~x~e ~g~z~' m~ma °
<br />~w
<br />a~6&
<br />~
<br />9 '~~~:w"
<br />«
<br />A
<br />" n
<br />a
<br />«
<br />a
<br />"
<br />~ m
<br />¢
<br />°
<br />~ °w "
<br />e
<br />` r
<br />•
<br /> s
<br />~
<br />g
<br />~ „~
<br />.
<br />my w
<br />°n'P~"~u
<br />sz~°sm »a a~k
<br />s
<br />q~
<br />;.a ~° r
<br />° ¢`.~°e
<br />IIR«
<br />a ~ag
<br />a ~g s~°
<br /> SAMPLE
<br /> MEASUREMENT
<br /> my ' 8fi
<br />°PERMIT
<br />° nB<q.°g a~.
<br />
<br />n.
<br />'R
<br />..
<br />a p'8~ae.na n~g~a'B
<br />
<br />' 9ffi6 R: m4 g°y i6p
<br />
<br />~
<br />`
<br />' °, bb gtt n. p~Aa m
<br />
<br />a
<br />~ $qq n6 ~n 4.wi ~a ° °u ate' a~Ma
<br />..
<br /> .
<br />REQUIREN6NT° 4
<br />.°wn~
<br />; ~a u
<br />¢
<br />'» •~
<br />°~~¢c.a '^0
<br />ae g
<br />~
<br />~'
<br />Yd b'tt
<br />~gen ~<
<br />~
<br />'a~
<br />'~i
<br />g ~ffi S}Po ~q w¢'
<br />g~
<br />g a~~x °«i„na >ae ,a "Frge'~:
<br />9
<br />
<br />Y
<br />~K'a .
<br />wi g •F'
<br />8
<br />~ .
<br />~ nffi
<br />~ffi
<br />a e°
<br />bv
<br />1
<br />a
<br />a
<br />% w
<br />w
<br />n.w
<br />s$
<br />~"
<br />Y'
<br />a _
<br />b
<br /><
<br />~
<br />Wrs
<br />B
<br />9
<br />'
<br />8
<br />°
<br /> . >
<br />k. ~
<br />$ .
<br />ffi
<br />8~e
<br />,
<br />~~a. .
<br />,$~w '
<br />n
<br />~'ri '$~'
<br />Ap,'
<br />New ~ .A r. &R~
<br />.~0,Po x®~..
<br />®a.
<br /> 6AMPLE
<br /> MEASUREMENT
<br /> e PCRµ'I.T":< .q 'm»g °n.<ss
<br />Pa $'
<br />A
<br />~~ ,Rau" .,sea ep.
<br />~$'~
<br />~+S~
<br />$ '~a®«°' .• °pvm
<br />0c
<br />~'8 °-,age rm` ~«•a
<br />~P&
<br />sA
<br />~d en. qg.w xe '- :q
<br />Bk
<br />~'x fi
<br />a '•.
<br />`P:re ~: ~~..«~
<br />~b
<br />H:6 .~".. gx
<br />e aa'
<br />
<br />'RE9UlR¢MEiNT' «
<br />.~.i y
<br />°
<br />° ern we
<br />i
<br />A ,y
<br />&.a
<br />¢e„
<br />« °waa
<br />~ ° F
<br />.a ,¢a
<br />.°y
<br />*e'v« ., a
<br />`
<br />e
<br />m » a.«
<br />¢zn
<br />ei
<br />e»."
<br />° Y•q
<br />Por
<br />Be
<br />b„
<br />ea., ~«y w ep""
<br />- ., °~b
<br />F °w .,
<br />:se.
<br />•a
<br />
<br />r
<br />a a.a~ a
<br />
<br />,•a o-~.
<br />Po u
<br />a
<br />~s
<br />«:e
<br />aae.m°°<°
<br />«a'e; ae» a.
<br />a».,
<br />
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ~
<br />' "¢.a
<br />~
<br />re ag°e`n ~e~sx
<br />«
<br />" ie~9«
<br />'&se ~` a.«a
<br />`m'°®nger ° v
<br />~
<br />~vs a
<br />:°'~
<br />x "
<br /> RIOI11pEltP,ryTg «
<br />" .
<br />"
<br />p ;
<br />« #p_
<br />~
<br />~ aw A
<br />A
<br />.
<br />t :
<br /> rBw Bw a&
<br />'`~a
<br />p °ffic ~4x
<br />a ~~
<br />$n 'a &m Aaar
<br />a x',&0 #~ae•YB.a
<br />~ g4xwx gR~g Pog.SS ~
<br />a
<br />a
<br />•
<br />HAMERITLE PRINCIPAL [%[CUTIV¢ OFFICER I cCRTIFr UNDER
<br />PENALTY OF
<br />LAw TNAr I NAVE P[R50NALLr E[AMIN[o TELEPHONE D A T
<br />E
<br /> •HO AM FAMILIAR wITM THE IMFORM/rTgN SUBMITTCD N[MIN AND YSED /
<br /> ON MY INQUIRY OF TMO$[ INOVIdIALS IMMEdAT[LY RESPp151lLE FOR f
<br />
<br />OBTMNING THE INFORMATIOV. 1 BELIEVE THE SUBMITTED INFORMATION
<br />IS TRUE ACCURATE AND COMRETE I AM AWARE THAT THERE Al1E SIG _
<br />I~--/-
<br />'>
<br />
<br />NIFICAHT PENALTI[5 Fpi SUBMITTING FALSE INFORMATON INCLUdNG -
<br />/
<br />~
<br /> THE POSSIBILITY OF FINE AND IMPR50nMENT 5[[ IB uSC 1 1001 AND
<br />]] usC 11319
<br />P
<br />e BIONATU RE OF PRINCIPAL
<br />E%ECU7IVE ^
<br />
<br />
<br />TYPED OR PRINTED
<br />f[fYYPYT AYO CYOI .u• r
<br />Pna
<br />v. undrr rbr mmb. m nrldr Dno W m EIM1Mn
<br />• or I
<br />•.d..rm•nnuw lnrPnu,nnl.rlr.,/Mlu•.n [nnnrA. wnd.i.nr.I
<br />
<br />OFFICER OR AUTHORIZED AGENT
<br />
<br />A A
<br />
<br />NUMBER
<br />
<br />YEAR
<br />
<br />MO
<br />
<br />DAY
<br />-.~ v. .-... ..V~I.• •vna lnrlr.rnar urI Y~IY4nTTIIII n.r./
<br />SLTTLEABL° 5:?LICS LIPTT APFi.I~S CilLY IF <_ !l.'-Y8• 24-H."l. PBcCIF I~V:;NT 75 CC4IMF:C. IF CLAP '~''-ROCr_P 'fv
<br />u~,JCUF TSB ~Tm;..i [iMT'"S -II f. ?P'" F(8 A.fPLI REP F ^r ., 1 c q_ ~ r;
<br />CG To D T~ F„:;L i'~'f '1... -_F: E' i.f'. i:1F ? '.~ rl'^ ?A4,?nF r•, r,
<br />EPA r 7 (Rw: PrBVbui ediROn9 miytle used. ~ IR[PLAC!^ BPw PowM rre wNICM rwr nor BE ueeo.l PwoE of
<br />
|