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~~ <br />PERMITTE ADDR ESB IInTIrrJr <br />FROLd A'mn ,nn r) drlerrnU <br />NAME 7"r~ ~• <br />_D D_E_S___----_-_ <br />FACILITY---' -------- <br />LOCATION <br /> <br />NATIONAL POLLUTA [NARGE ELIMINATION SYSTEM I.YPUF:.11 Pvee. <br />DISC HA RG NITORING REPORT IlAblk) 0. 1010-0gD4 <br />_ _ _ <br />C-/bl I11-/VI ApprOYl/~rpirBS 9-70-85 <br />_ _ <br />PERMIT HUMBER DISCYARG[ NuYeLR <br />--------- <br />--------- MONITORING PERIOD <br />--------- YEAR MO DAY YEAR MO DAY <br />FROM TO <br />aB~all lu./xr rzA-x. na a . x+s +or rxn.N, NOTE: Read instructions before comoletinD this loan. <br /> (J Card Onp') OU ANTITY OR LOADING (r Card Only) QUALITY OR CONCENTRATION <br />-ARAMETER Ub-SJ) 171.61) UH~3) 116-S1) (6~6/) NO. IRFDUENCT <br />or 6AMPLE <br />(!7-J]) E% •NALrsls TYPE <br /> AVERAGE MA%IMUM UNIT6 MINIMUM AVERAGE MAXIMUM UNITS <br /> b?-b)) I61L81 16V-]V) <br />~ . l e .. l'S. 6AMPLE ' - ~ T <br /> MEASUREMENT <br />l <br />C'~'+IVI. I I <br />PERMIT <br />:Lila waf:ur~ <br />- <br />v <br />T <br />x /, <br />[Ir/~/ <br />rcl <br /> REQUIREMENT ^l, _ i, <br />'r SAMPLE <br />1~ MEABUREMEHT <br /> PERMIT <br /> REQUIREMENT <br /> BAM PLE <br /> MEASUREMENT <br /> PERMIT <br /> REgU1REMHNT <br />' 6AMPLE <br />( <br />7 MEABUREMEHT <br />I <br /> PERMIT ~ <br /> ~RBOUIREM ENT. ' <br /> SAMPLE , <br /> MEABUREMEHT <br /> PERMIT <br /> REpU1RfiMENT <br /> SAMPLE <br />J MEABUREMEHT <br /> PERMIT <br /> REOUIREMBNT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICEP I CFRTffY uND[w PENALTr Of LAw THAT I NAVL P[950NALL• EaAMrN[D <br />AND AM FAMILIIR wrTM TMC IMIORMATION $VBMrTIEO N[R[rN [ND BASED <br /> <br />' <br />/ TELEPHONE OAT E <br />_ <br />I <br />)I <br />I I <br />7f <br />~ ON Mr rNOVIRr Of TMOSC MpvrDWLS IYMEDIAILLY RESPONSIBLE fOR <br />OBTAINING TNC MfpxYATIOn I BCVCVC irv[ SVBMrTTCD rNIORMATrOM ~ <br />/ ~~ <br />J J <br />~~~''V''''~`~ <br />!~~`/ <br />l <br />F <br />' <br />~ <br />• r <br />..., I AM A <br />i <br />R <br />T <br />A <br />AR <br />C <br />L ~ <br />/ <br /> <br />) I~C'I'fl-T <br />~• <br />'~!~('~ <br />r A <br />NO <br />w <br />IS iRUC ACCU <br />E <br />p <br />RRC <br />L <br />ryAl TMERL •RC SrL <br />NIIICANt PENALTIES FOR SUBMITTING IALS[ INIORMATION INCLUDING <br />~ <br />. <br />. r50 <br />L <br />r <br />L <br />0 <br />5 <br />r <br />T <br />C ! ' <br />/ <br />~ ~ <br /> rb,~ <br />11J <br />r 9 <br />P.naleC rrM.• <br />nm <br />D <br />U 5 <br />C <br />am~~ <br />r <br />mrlutlr /n.. ./~lu•nv SIGNATURE OF PRINCIPAL E%ECUTIVE tI J -~~..C <br />% <br />• L/ l <br />/ / <br />TYPED OR PRINTED ord.n ~rnNl..lrnr rnrP•r+.rn~r•'ru..l nr'N.••nFY..nrA. ond.i •.o... OFFICER OR AUTHORIZED AGENT AREA HUMBER YEAR MO DAY <br />L.VMMLNI ANV CwrLwnwrrVn V• wn. vrVLlarrVNi rnrlr.rmr uN urru.nmrnra n~.r. <br />) <br />EPA Form 3320•I (RIV. IO•I9'PREVIOU6 EDITION TO BE DEED IREPLACEB EPA FORM T-40 WMICN MAY NOT BE USED.1 PAGE OF <br />UNTIL SUPPLY IS E%NAUSTED <br />