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RMlrr[e NwM[/wnowcaa (lncludr nwTION AL foLLDrw«T oncH Aqc[ ELIMIH wTION srsT[M /NPp£11 <br />rdlty Namt/locarbn iJd' nll DISCHARGE M ITORING REPORT /DMRI <br />1M[-i~i~lil.sZ~i'.::: ;`L[~--- 1~lc 17~/P tlINOR Farm Approved <br />>-REZS13yi_5 iy-71~I,~--------- ' ~ (~UBR N4) R®M'@TNo. 2040- <br />-Fi.F :~~~------~1~~( t~L- PERMITMVMBCR olscNwgcfNUrsew F - FIUaL E%plres 9.30-91 <br />------------------- MONITORING PERIOD U1,C1fAiLli L' 'lU '1 it 111/UttY GKC GK <br />LuuTV _ <br />--------------~----- YEAR MO OAY YEAR MO DAY <br />,CATION FROM ~TSI- I TO 3 Y+JV V~ DISCf1ARGE ~Y$ <br />I <br />l <br />Pletinp this lorm. <br />c <br />i i 1.: C~ ~. Ili 7 :i r,. S T E Vr' fi S 1 V ? ff d'i I D F: N T Ro~1q l77~7h l11~1s1 1P6~171 (7819/ 134!/1 NOTE: Read instructions Mfor <br /> (J Card Only) OU ANTITY OR LOADING (~ Card Only) OU ALITY OR CONCENTRATION <br />fREOU EnCr <br />BAM PLE <br />PARAMETER (16~1J) (1161) (J8~1) (16~1J) (116!) NO, <br />E% OF TYPE <br />(J=.J7j •NALY515 <br /> AVERAGE MA%IMUM UNIT6 MINIMUM AVERAGE MA%IMUM UNITS 6161) (616N1 (AY-]U) <br />':I SAMPLE Y+{_it(-.,- Y.YYVVF ( ) v.. r. ( 1Z) <br /> MEASUREMENT <br /> <br />)4LG I L [a <br />''PERMIT"' <br />:~tr•~i::w~' <br />~' yy <br />s11:i1-~~A.. <br />~YY [' <br />Oi4~ <br />#.'Y{~t~m' <br />':n`~ <br />~~iD_° <br />~ <br />. <br /> <br />eE>tL~ <br />. <br />:RSg:° <br /> <br />FF1.U t( GF~SS vaLn(. REOW REM ENT <br />....,... :: •.'s."-,' <br />;..;.' ''::°'- <br />r:s## <br />f , <br />4 <br />c <br />!LIDS, .OTAL SAMPLE ^~'+'J+Y >,'". ~f'=C~'~ ( ) YY~YY'v ( 1Lj) <br />JSI'ciJCE: MEASUREMENT <br />~.~53~ 1 ~ ~ '.PERMIT' ~ .viY Y'v~.`.Y ~~~.~.--vt`., `Y' w~~` ~"YT~~~i-'J~ 3~Sj <br />' <br />" .1 <br />~~ <br />~ <br />aCE~' <br />RADA': <br />' <br /> REDUIREM BNT , T? <br />• ! ; ~ <br />, <br /> <br />.IL itUD :!iFASi'. SAMPLE ~'tr-~Zr: YYYY;=: ( ) #,".#,'-r;~ Ym:~;: ( 19) <br />1Zc01J L1_D-C;tAV ~~; 'I'( MEASUREMENT <br />UJSG I ~ •/ 'PERMIT.'. <br /> <br />~,.'.. <br />Y . <br />'Gui('~ <br />.. <br />~~ <br />~ <br /> <br />>. <br />YTi'Y {n`,.'-Y' <br />',. <br />.. <br />' YiY <br /> <br /> <br /> <br />. <br />.~'i~T''F t'7~= <br /> <br /> <br /> <br /> <br /> <br />"e <br />°Y~Y~t <br /> <br /> <br /> <br /> <br /> <br />R <br /> <br /> <br /> <br />A <br /> <br />Fr'LUdGT. GiOSS YP1.7F REOUIREM ENT '' <br />•. ' <br />' <br />.. <br /> <br />YYY, <br /> <br />_ V <br />... ... <br /> <br />.. <br />:tOh, T^.. F.L SAMPLE `rTY:Yi+i iJVV ter:: ( ) =ir>ir`J~i ~=JY ( 11)) <br /> <br />(A; F=) MEASUREMENT <br /> <br /> <br />'IJ4S I C G <br /> <br />PERMIT"; <, <br />~y ~~yy ~~yy <br />.'-',)t YYY <br /> <br />'l .Y ~ <br />"' ~A ,H <br /> <br /> <br />~yIyrr <br /> <br />•. <br />'./A lam.. :A~ <br />FYY <br />,IY~n <br /> <br />Y <br /> <br />YYN• <br /> <br /> <br /> <br />~ <br /> <br />~ <br /> <br /> <br /> <br /> <br /> <br />F <br /> <br />. <br />•e <br />F'TLU'IiT F1~SS VALII!' REOUIRCM ENT <br />'.' ' ' <br />" .. ~ <br />°.'°:' <br />.. a <br />:..r. <br />'~+~ <br /> <br />Y <br /> <br />• <br />r F , n ~ .. ~'e <br />e <br />y .. <br /> <br />. <br />LJw, IN CC UDUTT 0~7 SAMPLE ( <br />UJ) YYYY YI •'Y`Y'F'f ,f Y ,~ ( I <br />lR•IU TfiE.Tr EfIT PLAN MEASUREMENT <br />Jt1U~~J 1 C C '' PERMIT''. •'R $pQ,gT"~~~ DIITION$L' <br />• ~>r`dc:" <br />•~-..# ' .bt;,G#?¢CT <br />'°~ `,r%$.''-~y;u'X. .Y $E(i'LY' HSTAN <br /> REOUIREM ENT ~~ ~ •' "' . <br />, <br />s , , . <br />11". ~ S„ A <br />iOLIUS, TOTAL SAMPLE YYY`".r.=, ~%;:::,:=-` ( ) ###~c;; ( 19) <br />DISSOLY6, MEASUREMENT <br /> <br />1~29~ 1 ll i/ <br />PEflMIT , <br />",#YYY-'-I(>r,, <br />' <br />~ <br />" ~ yy~~ JaAy. <br />Y~•!YN!,Y <br />~~ <br />TYY yy ..yy` ~~yy <br />e,YYTT~Y~ <br /> <br /> <br />- <br /> <br /> <br />:. <br />OPYIpNgL. - <br /> <br /> <br /> <br />•': R13I?ORT ,' <br /> <br /> <br /> <br />BLY= <br /> <br /> <br /> <br />]tR:~" <br />tFFLU.it:I' :iH~SS V41.1J= REpU1REM ENT ' <br />' <br />-~:'-::. ' <br />;°.'" {F#;:4- r <br />..IL SIID .I:F~1S.•- SAMPLE YY.-i:~i~ ( 9q) .YYYY rt:#=:i:c: 'i%kAY• ( ) <br />Y ISU AL MEASUREMENT <br /> <br />z40E6 I 1 LI PERMIT Y:~Y'rFYiFY <br />~ <br /> <br /><..' <br />li <br />~ <br />~~ ~S- <br /> <br /> <br />1 YYM~•FY• <br /> <br /> <br />"' Y'F, M1-YVY' 1iY1R IY <br /> <br /> <br />EK <br />LY <br /> <br /> <br /> <br />SU$L <br />iiTFLUr:1.T G8'JSS P4LIli REOW REM iNT ';.:' ~~ ~ ~ ~' <br />"':' ' <br />t f)= ' <br />NAME/TITLE PRINCIPAL E%EC UTIVE OFFICER ' CLRIIfY unDfP PFNALiY Of LAw THAI I HAV[ PERSOnALLY [tAMIHFD <br />ANO AM FAM;LI1n WITH THE INf ORYATIOH SUBWfT(O HERC;N hND BASED TELEPHONE D A T E <br />L~r , `I • {J;~d <br />L~J V.JC OH MY INOUIRV Of iNOSC ;HDIVIO111L5 IMM(OI/.T[LY RESPJnS~BLf !OR <br />OBt A;NING THC InFO11M1TIO.V I BCLIE VE THE SUBMITTCO IHf ORMn LION <br /> <br />~ <br />` IS TRUE ACCUR.iC AND COMPI ETE I AM PW/.RC TH/•T THFRE ARC SIG <br />H•IIUNT PCNwI TIES FOR SUBMIITINQ FALSE MEORMAr1ON mCIUtlNG <br />~ ~ VVV "`~~~"~~~ <br />(1/ <br />~ <br />_ fr 11 <br />~Y1] <br />THL POSSIB•uTr Of fIN[ AHD IuT•wI50Nr.IEHI SCC IB USC 11001 /.nD / ` D ~~ <br />3 ~ <br />.t <br />u JI}( nJl h y~fiq <br />I tL~4A ~)u5C 11119 ,Y.mh... undo IArv uamly. eu• n.luJ. /mr. uP I•• llu un <br />I SIGNAi RE OF PRINCIPAL E%ECUTIVE ~TJ~ ~ 5253 <br />- -- <br />TYPED OR PAINTED •~+1 •••..;oa•I.I.nI.•e•I•••••n•••II ••/n.lu.rnAm••nlA. and '; •rr,.• OFFICER OR AOT HORIIEO AGENT AREA NUMBER YEAR MO DAY <br />COM M[Ni AND E%PLA NATION OF ANY VIOLATIONS IRr/rrrnrr ull ulludlmrn4 nrrr) <br />0[L G L'^ .t, S:;--Sf;°. Ft)UT.aJ]•~ P/, PAG13 3. dEP:)fiT (lN Fr.Ac,I9ILITY OF SALT k HJVPL RF,tJUIRiD BtiFOR; A7Y <br />LLSCiIAhG I~ :1LL7a~:D !'':~!)~1 :'lIIS POI UP--:iEk: RAT'IO•IAL~, PA:t': 1~. <br />EPA Form 1720-t (R[v. 0-88) ~rBVious editions maybe used. IN[PLwc[s [PA rowM T-.O WNICN MAY MOT a[ Ua[O.I PAG[ OF <br />