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:aq Nan./LOnnM UeU1mnU <br />aME CII(SI,IL[(LC-QA.I, <br />DISCHARGE MONITORING REPORT /OMXI <br />r' n M D A u v R-lal l17-l91 P _ F' T N A t <br />OMB No. 20/04000 <br />ApprOYal Aagna 6.7091 <br />!DREBaCnt.~~v~-~tl.~__---__-_-- ~` r ' F.6W t1iNe PIT~....TO..G99D_ SP.+i.`-i CNY. <br />~~~~~~'~~T(T {/y~1~~~~~~~ ., 1 ,' PERMIT NUMBER ;.' ": `0. ,~. DISCHARGE NUMBER `' I <br />~R9` ~'' <br />_ t!E F.HE.>L ~ ~. _ ..~ _ _~ SD_ tl1fL_4 L: -. ~ r ~ MONITORING PERIOD •" •~ ~•- :~ " I <br />~? YEAR MO ~ DAY YEAR MO DAY 'r ~ ~ <br />~ <br />E' <br />'. <br />)CATION ~~ <br />[;FeDM Ty ' tl7Nllp (c11H1; N4)'~ °~1!1FA'! <br />_ -~_-r-y: <br />- -- - - <br />. <br />~. <br />r. 5 ~ C 841/1 !!!-v !167!) ~~ ' !!6771 ISa-791 I!alll NOTE: Rsad InalrueUons bsldr6 eompletldg thla lorm. <br />.t ~ <br />MRAYETER <br />4 ` <br /> <br />-! (Cold Onlyl O OUANTI OR OADING `+, i; (IG OnlYl'~ QUALITY OR CONCENTRATION <br />!!~-0Il <br />(!call `' 116,)!1 ' <br />(Ib!!1 "'" (!ball '^ .. <br />~ tJ :. ~ ,~ <br />p~ <br />I. ~ <br />~ <br />FREQUENCY <br />8 PEE <br />t <br />!!7- fJ'q <br />.! ,n V <br />t, <br />~ >, !': , <br />c <br />AVERAOE'~ ? "r. A~A%{fl1UMi ~ 11NIT6- ' ~ u MINIMUM AVERAGE / MAXIMU E <br />,UNITS; ~~ ~ OF <br />(A~a <br />a9-701 <br /> <br />'ll o „ "sAMPLe ° i~V##~ a O~#6j#u <br />' ~ ~ { .~ •; ' '- #t/#### °: " °; ~ Q ~ <br />va ~ <br />. MEl18UREbENT~ •~ :t O ~'1 n ~ ~ tl I- ] ;.r N ,T, ,., - n <br />O <br />IU4U0 <br />1 0' ~D "' p' N r #~3 ~. ; ~ r ~U] ~. B <br /> . <br />iULIDSa TO'!~b D ~ IQ#4#09C= ~$OL}ON#y~ <br />' <br />~ <br />" 4 a ~ oe O#4111## <br />v7 `.,i° S ~ M1 <br />r w V <br />fo <br />a :, <br />IUSPeNDED }S.~ YEAau EgENt <br />. " <br />. y S~.J1 <br />' <br />'~ - ~ a. - _ <br />O <br />... <br />, - <br />~ <br />~t Y r,~ <br />, <br />.i <br />IU5l0 1 a"~0 i ~ ~. , ,:: <br />. <br />~t ~ '~ 1 <br />~ ~-C ~ ~ A B <br />I dl'4#~t ' 1 ~ 1 <br />IOL1D9a SB`~{yy~CrBABLBe. 6,'B~ P``E1.' ~ <br />' <br />~ q14~ 4 #': <br />C. <br />~ I= <br />' rS m ~ <br />p <br />' - ,SI1b)71## <br />' CT <br />~ ~ R:'.,= 3 <br />" 3 •° <br />P` <br />; ~ ~! ~ ~, <br />7L E(AENT (.. <br />MEABU P, <br />~ • <br />- G n1 a I~7 <br />J ~ <br />~ <br />p S r <br />+ /^ <br /> . ~ <br />. <br /> od <br />, <br />p~ <br />IiL AND U_R ~~y.. q~yj e! qq <br />L ~4#4~#, <br />~a~4] ~j' ~y <br />'~P'~OC <br />' ~' J Y ~ 0!~OYi## r :'1 ' <br />O ~' ~ C c p0 ~ <br />`~ MEABURE <br />GENTIA C j <br />o - h <br />'RBUN ~XT <br />-~iK11V <br />B'~t <br />- ~' ~ ~ <br />9 <br />~ .. o ' <br />~ ' ~ <br />IU556 1 <br />~ ~ ~ 4 p1~01 a I~ <br />~ <br />,}: d ,~° ` i 3 <br />~ <br />~ `~ ; R .~{. $ ~ <br />~ <br />~ , <br />~ ~~~ n <br />~ ~ (! <br />.HUN TOT <br />a ~~~ ~ ~ .n eAMPL6 Dc <br /> <br />MEABUREMENT'~ a <br />!~#O## '= #~#a <br />Y <br />~ # <br />V ~ <br />~' %3 x+71.- ~10' ~ <br />+ w " :1 -. ~ n .... <br />o <br />'+ ,j <br />r1 I T " <br />O ~ u '~ <br />~° a . <br />i' <br />i~ .y y <br /> <br />~ n !t , <br /> _ ~ <br />V ~ a <br /> <br />I I.UUS 1 nV y ` '!r+lM Q I ~ N~~ ~ '•}~1~Ir. aa(1~'(~IYY~ n' <br />~ U MI = l~ P ~' <br /> ' . <br />"LOMa IN GCIlIDUIT ON- "'SAMPLE n• 3 ~ ~~ ~ <`• <br />~ (~#q.4i1+(+~ 0 3 ; '' ~tX##u+v °; 'a~414#0 ~ #G#o ~71# <br />' i " ~ "~ Qr O V <br />[ II R U T R E A~' <br />P LA 1F~' MEA$UiIEMENT ~ '' ~ <br />V <br />- ~ C } ? ~ ~ <br />~0 <br />iOUr+O 1 5 f l 1 ~ .o n .h~ `;y ~vS'e l.I:' ~~9 ~ ti: #r4+i~ ~ N TAN <br /> , , - <br />3ULIOra TY~Y e' I <br />^ I ~4tF17~#s ~. <br />5#Iti#'p t'~ <br />' L >~ ~ '~. p'd~~}4~i p fi!T>01~### : F W ~ o J m r• <br />1 <br />)[SSG Yeo° ? '~ R 1~1€ABUR <br />iMENT <br />' . <br />, ~ T <br />~ ~ fV 1 <br />rv <br />~ <br />~ ' u <br />~ a ' ~ ~ ' <br />1'1295 1 'oa i.o <br />' v <br />ti t x~ <br />Sa , ;i: ¢ ~' <br />o i <br />;"N~d~ ..r _ ,y ~~ <br />1f;# N 8 <br />., G k <br />r ,¢ <br />' ~ryr•~ ` <br />, • , 5.• <br />y ,~ <br />NAM LE PR NCIPAC EXECUTIVE,OFFICER ;~. :1 CERTI FY UNDER PENALTY OF <br />L1W THAT I HAVE P <br />E ERSONALLY E%AMINED j~ <br />' v '' " <br />A <br />N <br />A <br />E <br />H <br />'' <br />~ <br />, '.' TELEPHONE , <br />~' ~ ..~ D A7 E ; <br /> <br />R Q' 'i <br />RICII i-ckine <br />~ ; <br />. AND AM FAMILIAR WITH TH <br />INFORMATION SUBMITT <br />D <br />EREI <br />ND BASE <br />- <br />~ J <br />ON MY INQUIRY OF 7HOBE INDIVIDUALS IMMEDIATELT RESPONSIBLE FOR ~% <br />~ ~~ ~ , / <br />I <br />T <br />TTED INFOR <br />AT <br />ON % ~ <br />~ <br />• ~ <br />M <br />BM <br />~ ~ (, <br />~ ~~ <br />gn ' <br />• <br />VI CO ~ IBtT~1EI1Ci , r i; <br />OBTAINING THE INFOR <br />ATION. <br />BELIEVE <br />HE SU <br />I <br />M <br />I <br />9 TRUE. ACCURATE AND COMPLETE. I AM AWAPE THAT THERE ARE SIG- ' ~ ~ <br />~~1FI <br />G FALSE'INFORMAifON <br />INCLUDING <br />N7 <br />EN <br />LiIEa FOR SUBMI <br />' <br />TI ~., ,, <br />~ -' <br />~~ :` <br />~~ <br />1^ ~ i <br />-• r• <br />- , <br />P <br />, <br />CA <br />A <br />N <br />T <br />'THE P0991BILITY OF FINE AND IMPRI60NMENT. SEE 18 U.B.C: T 4001 AND ~ SIGNATURE OF PRINCIPAL E%ECUTIVE <br />= <br />' ~ 1 I <br /> <br />•'- ttPED OR PRINTED J7 U.B.G 1 1616. IPr,Wtla nnM rhra nmra lnsy Ndndr Jbe y <br />1o a/RaOD <br />.•naermuAnu,n lmWroninenrq/Drrrten e,nonlbud ftea/a/ OFFICER OR AUTHORIZED AGENT <br />.NUY6ER <br />TEAR <br />MO <br />DAY <br />COMMENT,~IND EXPLANATION OF ANY VIOLATIONS/RS/eena aYsnaebnenO AerFJ I I <br />i''JN U~L f.'CAE~ISF, SF.,F, FOOT N!)TE F/ I11 TII F. PERM I'f. S'eTTLE 411L~ SOIL IIiS IE.ST RE:I~U IkEU t7NLT"IF C- 10-TR, 74-II~ <br />PIIE('[P EVENT CLAINRD. fF CLAItI ADPRDVFU RY 110!: U, T55 6 Ir'0'I I,T/'IT; '+t LL tl!)I HI' 0.PDI,fFb TD FE PORT F: I! <br />' b .9-BB) rI OA ITIO m U 1 C R ~WNN:N YAY NOT EE USED) -AGE OF <br />00(1(13/~C111G'1-1676 l <br />