Laserfiche WebLink
PEF.'I ITTEE 'TAME/ADDRESS llrlrlnd• NATIONAL POLLUTANT p16C MARGE ELIMINATION SYSTEM 1YPUl.]) FO/T App/PVad <br />f anon Aumr /Lm aunn I/ Jl9r m^(I DISCHARGE MONITORING REPORT IUSIR) OMB Na. 20lO-0DpI <br />_ _ 1: ~ I e 1 l I ]~ IV I APP/ova/ aApi/aa 930-B6 <br />NAME 1 ' <br />-- - <br />AODRE69__ 1- -+ IL ___-___-___ ...~~.._ '. '_. I <br />L .' a _ . ' <br />'' - ', .~. PERMIT NUMBER mSCwwRG[ NUMa[R <br />. Li:... ..: •.. _ <br />MONITORING PERTIO-D <br />_ACILI=Y _(' IC r'~)IF. _______________ YEAR MO DAY YEARI Fn0 DAY <br />LOCATION FROM I J ~ I~ TO <br />(:0~J1) C1-?il (34-1J) f1e :71 1: n'.?YI !i0-ill NOTE: RB6a IR61luc11oRS before completing this IOFm. <br /> li Card Onl)') OU ANTITY OR LOADING 14 Card Only) DUALITY OR CONCENTRATION <br />PARAMETER I4e.Ji) (J4~611 U8.4S (16-J3 <br />) IJIfiI) <br />NO. <br />FR EOOU ENCV <br />SAMPLE <br />(JS-J7) E% whwL rsrs TYPE <br /> AVERAGE MA%IM UM UNITS MINIMUM AVERAGE MA%IMUM UNIT6 <br /> 61-0J) Ie1-0tll 16V-0B) <br />11 <br />EI Dt~ 6AMPLE ~\C1 D)scnz(• e <br /> MEASUREMENT <br />G[ <br />JDDUiI ~ D <br />PERMIT <br />~ ~ <br />* <br />DilO7 TT1, <br />11': <br /> REgU1gEMENT <br /> 6AMPLE * * * <br /> MEA6UREMENT <br />0 I G <br />/ <br />~ REpVIREMENT * * * O11 <br />i0 GR <br />. <br />i . <br />IP,Ot~ MEASUR MENT * * * <br />185 1 0 REquIneMENT * * * <br />01/30 <br />GR <br /> <br />SETT. SOL 6AMPLE <br />MEASUREMENT <br />* <br />* <br />* N <br />I <br /> V <br /> <br />5C5 1 O RHOVEREMlNT- * * * OPTi4mPi 01130 GR <br />TDS SAMPLE <br />MEA6UREMENT * *, * <br /> <br />/1 <br />70295 1 U <br />gEpUIREMENT <br />* <br />* <br />* (~~ <br />01~9D <br />Gk <br /> ` <br /> SA. <br />.IPLE * ,* * <br /> MEA6UREMENT <br />SOU 1 0' PERMIT <br />REOVIREMENT * * 6 5 * 4.0 01/07 Gk <br />O nEG MEA6U REMEENT * * Yr <br /> <br />550 ~ U RHO VER EM EHT rc * * 1 <br />OPTPION <br />10 <br />U1l07 <br />Gk <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' C[RTRr UNDER FFnwVV Or uw THAT NAYE P[PSONAIIr EafMInED <br />AND AM FAMILIIR wITN ihE rNFORMATION SUOMITTCD NLREIN AND <br />ASED TELEPHONE D A T E <br /> <br />Jam <br />S <br />L B <br />ON MY IMOUIRY OF TMOSE rNOIV IOV ALS IMM(pwTELr RCSPOMSIBL[ FOR '` <br />T• / <br /> <br />es <br />. <br />unan <br />OBiuNING THE IMORMATON I BELIEVE lw[ SUBMITTED MEORMwTrON ` <br />J ` <br /> <br /> <br />Manager -Permits <br />IS TRUE ACCVRAT( ANO CCMPLETC I wM AwwRC iNAT TNER[ •RC SIG <br />hIFICANT PEM1wLTIE$ FOR SUBMITTING F1L$[ INFOR~wIION INCLl101HG ~'/ <br />J <br /> <br />r)pp <br /> <br />F f <br /> '~E PCSSIBrVTY OF FINE wND IMVw15ONMCNI SEC IB VSC 1 IFpI •ND rl!r/ 177Y-~L` j n7 1_17 ~~ <br /> J] V SL 11]19 rY.nole.- uMr• IAr.r •(e(u1~'a nrOr rnrl <br />A. Iln <br />{Il~ill.l EIGM1 ATJRE OF PRINCIPAL if ECUTIVE <br />TYPED OR PRINTED u <br />~. uY I.. <br />orW.n mrrlnlYrrl any"L•mnnV nl er~wenemnnrll. and :..rn' I OFFICER OR AUTHORIZED AGENT I AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENT AND E%PLA NATION OF ANY VIOLATIONS IHeJnrnrr ul/ ul(urbmenU M1rre) <br />UNTIL SUPPLY I6 E%MAU6TED <br />