FaeYFJINIrtfJLaT@ba pall a~llJ ~,'/'-}~~~ ~- •~j}s~; F}'-e21! ~ ""~'. '\'> C'.~ D18CHARGI
<br />N wMe 7i\f 1c: ~c I•S t;l_!LOA ~YLi fnsi ~`' ~ '- /7-I6/
<br />~'~`~: tom, t'~<`'~~' fir'- o
<br /> '
<br />I'
<br />'
<br />L'
<br /> JL F'\c L
<br />.
<br />l 'r
<br />. e
<br />•
<br />______•_`~_, 11_L___ ,'.~ t_^_~~__ PERMIT NUMBER oucxwwc[xuraaf .'-!.~
<br />;
<br /> a
<br />MONITORING PERIOD ~/•: ~'
<br />
<br />PACT LITY ~ ^
<br />~~; . 1
<br />---~----~---------------~ YEAR MO DAY ~ YEAR MO DAY
<br />LOCATION FROM _ TO „ -
<br />I ~ (2411 !7113/ 1N-15J (1617/ (1819) 1343 / NOTE: Reed inftruetiom before COTpletiny this torn, ' ~
<br /> (3 Card Onlyf OU ANTITY OR LOADING (4 Cmd Only) OV ALITY OR CONC ENTRATIOM NO PREOYtrCY BA
<br />~
<br />PARAMETER /44531 /54-61J /38-IS/ /46531 13461) oP MPL
<br />Y
<br />~
<br />/3737) E% wxALYMf PE
<br />.T
<br />a
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITE 6E63 /64-68/ :(6470/-,~'
<br />
<br />. MEASUREMENT
<br />,4 .. ..•.1 PEItMI~ .. i .7'~' ~ I} .: ': .) 7`7 13. '#' ..w J _: Y ~. '.'-!IIQP rNf~'?- ; ~c'Ne4" .~
<br />1ki
<br /> REOV ~iEEM,ENT • •
<br />! t 1~> . . S
<br />°"
<br />~y1` !`
<br />^ . ..
<br />i# , 1 .
<br />. l.{ v~l.vl 4AMPLE ,¢''IF~ rr ~. ~. .~ qs
<br />"
<br /> MEASUREMENT '~1
<br />. .. 1! `.~I
<br />J4 ~ .
<br />.
<br />1r L 1/ ...P6j~•j~'jS /' iL ~ ~
<br />! y~x.
<br />'. y~I:T•Y~!.Sr•~R '!'} I! ~T'`/'"A
<br />n y~{{.{} ~~., .~.j
<br />7a~
<br />i ..
<br />q~
<br />J 1
<br /> R[b{I/1[EME T Y
<br />{'
<br />I ~~ I .} d ~~
<br />.;/ _ ' r.
<br />1
<br />/-
<br />• .~
<br />• .~ :
<br />•
<br />. . / v
<br />F ~l _,~ h~_
<br />. ~ SAMPLE 'yF ~.} .n' ., p.P I: 4t
<br />.S:1 y. • '1
<br />
<br />, MEASUREMENT '~
<br />..IJ~. 1
<br />.1 PE MIT,ti / aFT~`~~'wT .1 ~'llyl~+~•~~.. .J t7 ...~ 'I~ 'lt' -'.,,y ~r r,, •^{~L"i, ` q
<br /> a~
<br />
<br />I 1 ~ • ._ SAMPLE . •~., tY• ,.. o. Cr ry, l .. a:
<br /> MEASUREMENT ..
<br />`~,
<br />5~ rv
<br />I
<br />_
<br />-i •
<br />IEHMiTw~ '
<br />,p., ,~:lfl p,
<br />#p.j.i` t $
<br />•. .
<br />>ji itX1,
<br />~
<br />r
<br />~
<br />,~~1}f~a1Qa
<br />'L
<br />'~Y
<br />(
<br />:n
<br />
<br />;~
<br />.
<br />' .REOV EMENi ..'r y. }0 Y a.
<br />. l a.IC ,I +T~
<br />-
<br />~
<br />~ k~ t
<br /> . / .
<br />' ~• a :. I 1 ° .. '.; I ~ ~.~ SAMPLE ~
<br />~ A i, it as ; :~ dl +.. ..-'n .: i•
<br />~ ~ .
<br />. .
<br />MEASURCMENT
<br />~
<br />'
<br />C ' •: 1
<br />L' ; .Pt 4fITy
<br />SS '.. ,I ".~Y.
<br />7 ,. ~L"YS~. ;j ~ ..:F 7-IH'34it,
<br />~!'
<br />w
<br />/
<br />. }
<br />~~' a"~:" ~'~'~( • . + .~ .
<br />, .vv
<br />,Ji80U ~EMENT . R
<br />' ,.
<br />.
<br />. 3
<br />
<br />,:;LL..~.ra Il.l/.L (AMPLE ~ I ~~3¢}:f 4-?~~F\a MAr4:.a).:I. ": ''•~
<br />
<br />r MEASU REM ESIT N \~
<br /> M
<br />` .
<br />a .id .
<br />~. r .1 t. T
<br />RE4 E
<br />..~b a
<br />+ w' e, ..q .
<br />,t '£: r,Sc' h
<br />k E. .s~
<br />t
<br />r•.. {~h:.[
<br />/ 9AMPLE~ }.i%N,: :.- -!•: •i 1.. v: i~ -f .. ai'4 .=.'e -
<br /> MEA4V REMEMT
<br />... 1 i/ (P rcc Y. ..Y, 'P ~' t
<br />~
<br />~ ~~~t>~3y .: ~ ~TS Y# L.'i~ ~ 'if - L L'•„ /ir
<br /> tiREO'U E MT +' .
<br />, ~ '
<br />
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFPICER I ownwr wPUwvre owrwr~oxa rPwaonwi^: - ~ TELVHONC DA TE ~r
<br />
<br />rwe~+~ a rweaa
<br />e~
<br />x e1
<br />~~o
<br />~
<br />~r
<br />l
<br />n ~~ .
<br />u.~ f
<br />_
<br />~ rwrw.xa rxa Iw.ewrwvo
<br />u
<br />Y
<br />T a
<br />nra
<br />wnew
<br />l
<br />a
<br />. - /
<br />.
<br />~
<br />' w<cuwwra w or...ra. .xwr rxa
<br />a ua an-.
<br />muni Pawwmn • cauarrcnwa w~owrwr.ew, uoe~xe-
<br />iw
<br />+a
<br />w
<br />~ './ l
<br />~ .,: •~ ;' ,' ~, r
<br />~
<br />-
<br />r
<br />•
<br />
<br />I j
<br />/
<br />~
<br />-
<br />rwa roeu.un. e. wlw
<br />wwo Ir Pwnewrae
<br />av a u.a.e. /
<br />wI wne
<br />w /
<br />-
<br />e n
<br />
<br />"
<br />'
<br />a ..e. / un. (Palallies WldR NlRIIOfYN1I^OY Iwc(ade fiwtJW 1077 a, 000
<br />SIGNATURE OP PRINCIPAL EXECUTIVE
<br />~~y-
<br />/
<br />r
<br />. _ /
<br />TYPED OR PRINTED ardJor alaiure(af implvfinenlOf OaMY[n Qmm~Nf arWSysaR/ ~ OFFICER OR AUTNORI2ED AGENT CODE NUMBER „YEAR ; MO, DAYS
<br />wMw.enr wnu rA.Lwnw nun ur wnr vwL..rwna (Xgoenttml Eelatnmenrznny --_. ..- .
<br />L:'.:,. '~~ _..,_ ..~ F. ;'r ur. is ,•1J {. i,nii _'I 1DJ1 ti'ut .Y'~'_.. I:i _ ~,. ,.o -.t::Li i: x LLlJ:•:S I'kr. . ::.`i .. ~..:
<br />~.4 n. r. _!L. eA;.~ ~.~_.:;3~ r.>>=` PFC.- =Gw =_"7 :5•„~~-.r.. ... .i. .^. ..?{'S.•; N~_~ ~~_ _L:J ~CJ~e'
<br />EPA' Form 3320.1~11ier. 7479) PREVIO U! EDITION jQ, eE USED (REPLACES EPA FORM T-40 WNICN MAY MOT BE USED.I PAGE OP .
<br />UNTIL SUPPLY IS E%NAUSTED. Li li CiLL/C:Y i~: .:°1/rt,., 'i
<br />
<br />~~ ,
<br />° '
<br />-
<br />-~
<br /> L
<br />y _ _
<br />
|