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I[RMITT[[ MwM/rADDR[ff ((n (IYd( MI.TIONAL rOLIV T11NT DI]CHARGE CUMIN ATION 1r STCM I(tYUt~l F•Alry Naue/Lon dIJJe[nr/ ~ ~ DISCNA ONITORING REPORT lOMRI nn~1.s-p~,~rnAt r~15_.H~°..C~SS~-- 3 17~r9 ~INnR T wonwsm17f1"1 an(ITN rare _____'_-__ T (SIIBR NW) ___ FLA ;STAF~______~_ f~~L_ •ERMIT NUMB[w olicN~nc[NU.. •.R o ~_ FI NA L Form Appr~ RAM4'INo. oooa Explreb 9.30.91 ~~ ACUTE WET TESTING. FOR VU7A MONITORING PERIOD _ IACI LIT7~~_~-~_-_____---_ YEAR MO DAY YEAR MO DAY _ LOCATION _ _- FROM To I N~f) DI.iC11A1 CF~ -- _ ~ /30111 173331 l31-151 l16~ I l38~391 lJO~ !I NOTE: Re[d instructions bef plating this form. 1 N i T F. V ~ r(S () J ' ~'+ ~ ' (J Card Only) pUANTITY OR LOADING (I Card Only) DLIALITT OR CONCENTRATION ~ ND FR[OU[Nty I B -ARAM[T[R (~bJJ) (Jlfil) (JBIJ) (16.lJ) (J•61) ' x OF TYPE (37.!71 ~c -- AVlRAOE MAxIM UM' UNITE "MINIMUM AVERAGE MA%IMUM 'UNITE E 67bJ) AN wLVflf (dl6B) (69-1U) P/P STATRE:_ugRR ACU. ~BAMPLe caaCaa aaaaG+i (_ ) _ ar..a*aa ( 9A) CE RIODAPnt1IA= MEABUREMENT . TGM3Ei 1 0' ':0 ~~eiP6RM1'E«~'> ;!Sl.~c!C:?$~r(7.v ~' m ' ~ix~~~~!t~~l:° .aao p °ftC~ PT ; r,"~ ~~=~ i~";# ~~"tR r ? 1?EPDE!T` A55 0 r~r ; > 2RLY~x , Ei',ZA P T R ~ V LU REgU1RiM 6NT• ' ^ '';r. ° :gi.; :r ~, " aKc t<a q , «a". a:y; a ; :. :.ro _ ~ "5;;°: ' , P/F STATS(E 96RR ACU 9AMPLe aa>-saaa - waaaa+x ( ) -. ~laaa~a ( 9A) PIf1EPRALdS'`PROMELA$ M[ABUREMENT . 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"~ .`e .~r""~ .e av 'Y.a> R s sa'~.. ®a ~y.i g ay ~, na:;-,~«g ( b , < a ' ° NAM[/TITL[ PRINCIPAL []ItCUT1V[ OFPIClR LAW THAT I HAVE PERSOMALIr [[AMINED r CCITTIFY UNDER FENALTY OF __ ~ 1' ~~ I ' ~ : TELEPHONE DATE ~ ANO AM FAMILMR WITH THE INFORMATgN SUBMITTED HEREIN. AND MS[D - , ~ ~ ~ ~ r- rte. } 1. ~y / ~1 N/{ WC) .. =. :' , ~~ ~ I ON MY INOl11RY OF THOS[ IMpVIDUALS IYMfdATELY RESrb151BLE FOR OBTAINING THE INFOPMATIO`!. I BELI[V[ TH[ $UBMITT[D IHFORMATIOH . ) r' / / _. - ~ ~ '~ ~~'~ - ~ i ~Q ~ ~~~ ~" -' C .IS TRUC ACCURATC AMD COMPLE![ I AM AWAR( TMAT THCRE ARC SIG CAMT PENALTICB iOR SUBMITTING FALS[ IMFONMATIpr 'R1CLUdMG K ~ L r(/ ~ ' - r '( +-I (IS1l~• ( C1~V11 a~~Ll lts. N I THE FOrSIdUTY OF iN[ AMD MPR50NMENT SE[ IB USC 11001 AND 1 ' 616NATU OF PRINCIPAL E%ECUTIVE ~rL •~f /7y' SZCI q /,J ~~ ~ ~ r ~~ 1]19 rM1gl(v. rMrr Ib~ .IamN. wrr mrldr /wi y In !14/rrr ]]USC A TYPED OR PRINTED •M.v nrinnuw rlnPnnMnl.rrr ~./hrrrrnf TnnlA. And.S ../r.r OFFICER OR AUTNORIxED AGENT NUMBER YEAR MO DA COMM[NLAND [[PLANATION OF ANY VIOLATIONS (Rr/rrrnrr •!! uuurhmrnb Arq) , V: ~. _1 SEE PART ~I.P (1F PF.R;l[T FOR DETAILS OF TEST PROCEpUf?F.. RgPOP.T RFSIJLTS OF IBC TEST AS '[MTNiM(I.^.'r ~tND SG; lf7RSALITY TEST (ANT CONCEVTRATI04) AS 'rnAXi!".Il!1° A11tJ ATT0.~N ~rlrTf' T07:ic.'I':'C TEST RF.P7RT Fn^M TO ?''1R. FOrlll ~1 (R ) ! tlbhllm bB Used.' ' Iw[PLAte^ [ir[ ~dRrr ' s'MNI MAV NOT B[ YB[D.1 Pwoe of OGi1R5/910615-1241 7