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E I~ODRL~rl.Fs~r/L«~(Qfrren~ _ <br />NAME ! .1 1; ii ., .(~ to ~: t: ry ii .~i'. ia' '$ ~ .l. ` ~: r <br />ADDRESSE:: ~ ', ;:i ;~ . J ;,3 ~ t:1' I ti ~s o t.~. t~(' <br />t~it:';(~:'i:'~. fr'rti.wl.,i i. ; !?. :3i}~. . <br />FACILITY 'E.:11 )'t, '':'r 4i IS ~ ;? "~! (; '?' .~ ::~ iv ~! :Z r~ ~ . <br />LOCATIOr(,: L+ 'S k ~~ C: J C. 3 "~ 1 -~ t 1. <br />f`: ~). 1 (! ~ `.t . X . ~ Y: r.'? Ta i4 IT'F : , !K t ~~ 4' . > ~ ~ :. ~4 'i' <br />• . OISCHAR(iE MONITORING REPORT /OMRI eq ~ :, ~ :~. ~. ?~ <br />PERMIT NUMBER ' ascilAaoc BuMe~ft ~' '- . ~ ;r l~ ~ ~', . ';, S~ i.,. a <br />• MONITORING PERIOD . <br />YEAR: MO _ DAY YEAR . MO DAY ...~ <br />FROM ~' . V ,: TO . ' i:+ e a . ;~ s ~.;.~_ t tl' ,y i`} 1 ::i t. f "; l:.i,; ~ ~~ ~ ~;i a ;'; <br />` NdTEc Reed hlettuctlofa befa~~pNtMp thle;itxm. " <br />.PARAMETER , QUANTITY OR LOADING `QUALITY OR CONCENTRATION NO, <br /> <br />EX FnECUlalcr <br />.OF , SAMPLE <br /> <br />.. <br /> . AyAivsis TYPE <br /> AVERAGE ~ MAXIMUM UNITS MINIMUM .. AVERAGE MAXIMUM . UNITS <br />`h SAMPLE ~,,a,•. r g:'j;rc m.~t:~x^r,t;, .)' <br />' "'a~. rr ~ t7 ^ } <br /> MEASUREMENT . . . <br />s;~iy :J:.l' y. C3' 0 PERMIT 'ur~~ ~~>ti~ <br />~ ~.~11~~?~A~w ~+ . ,1 ;~ J,~ ~ T: ~rr~~~ a ~r .1 ;~ ~ ~ /,~' ~~:~ ~'t; <br /> <br />~, <br />., <br />w.k'r Lti'~,,~' :%+~lLla~'~ ~' d:utle REQUIREMEfVY't a~+x~catio: t?~~;~,~Ni~an <' 'ti 7.~~!:3~ ,.3,) ;, I`" .~~,•~i <br />'3 t;~ L .t ;~~ .".i ~ . :: ~; Z ~.' L 2`` A ~`.~ a, ~. SAMPLE r ~,~,..~r:~, 7:~. ~ r,,':,t a "P t ~.. ~~ ~ - ~. ~ } . , ,• <br /> MEASUREMENT ~ <br />~~ '''~ <br />' ~ y~y~~µ ° <br /> <br />< < <br />:1. <br />a s 1 t~ +~ PERMIT ;; ~ ~ ~ w , , ~~ <br /> <br />~ y ~ '?W ~ ~ C k ~ <br /> <br />~ rtf _ <br /> <br />~ <br /> <br />,,.{' ~ <br /> <br />< <br />JY ~ ~ <br /> <br />~ <br />I~ ~I <br />,, ~ s z <br />f' i° :: t) . ~ c a ..~ ,'~ `7i M V it ~, t'r I, gEQIIIREMENT. ~ <br />Er ..,. ; <br />v ,; f <br />! ~~ : ~, X ~ <br />~ ~. ~ ~ <br />/ i. tr <br />. <br />~ ~ <br />.~].;:. 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L' ~. a 4.) {~( SAMPLE f %; .f ), s:Kr. ~~.+;~ vrr ~ ~ :«~ +:~ " X.~.t;~:r: .•n ., ~r .,a vtAt'r <br />.T. ~ ~ .,, ~ a ~; 3 * ~ <br />is ;~ ii u .:.; ::.N , ...~'I' 'F 4..41 t MEASUREMENT ,.,~ <br />"• <br />~ <br />' <br />:i~~t~.~ta{. ~. s.~ ~.~ !`'EpMl1` .I•tt•:F'~~7R'~' i~f,l't.~,~~ ~;r <br />~~a~ <br />- ~A~`+~:~u~n ,,;,x~-"r%~~i <br />~. r~' "s~L~.~ <br />` ~~~~+'~A~ <br />:~. ~ LG u' T t~ f 1 y .1 N, :~ ~ Et1U1REMENT <br />p <br />::::::::.:..................... ~~N ~, ~. ~t ~ ~? ~'.~ 3;Y ~ ~ "r;;:~ ~~ ;~ a+M ~ <br />~ <br />~t,s~,.Z.i)~r i.,:~T'7!:.. SAMPLE *,;~~vra x ,;a::,a7•^sl: , .. ~ ~~~ <br />Lt ~ ,':~ ~ i.t L k :; ii MEASUREMENT <br />±.l a '~.!' as ~ ~ .. ~ ~ ~ ~ <br />x ~ <br />. U~' <br />L~. .:..;•:: <br />~+ERMIT ~ <br />'~?~~,wT;r <br />~ ~ <br />~ ~' ~'4. ~ <br />,: <br />'Ct ~ r' ~ r, <br />+r~•~~ r ~ •-~ ' <br />~~:1`'~. tT ;~ <br />~ ~~'"sF~..`.r"'~ ~ <br />~'t."~~.~ . <br />~ kS~i~'" <br />. <br />• <br />~`: 'r F L L' ~:: ,'~, :i !; fl ~ 5 :i J "; v t;' ~ ;E~:t]t11FtEM~N'I` _ 3;~ •^• ..c •7; '~ i3 >~ ~ , t ~i ~ ~;~t ~: 7~ $ .''? ~( ;~: J !'.I, - <br />~..! .t. w . . ;v „~ : ~i.: A ~ SAMPLE ,.. r .~ .. 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TELEPHON E <br />" DATE <br />TITLE <br />RIN <br />NAME/ re red under m direction or su on In saordsnce'wlth.s system dol~ned - . <br /> <br />~ <br />~ , <br />f <br />~• -.•~..... <br />-{ r,,, <br />~ l~, ~. t, ,. <br />.. ~ t 1 ~ ~ P!~ 4 4 <br />r to assure the gwelied personnel properl7 ether snd eeirl4.te the InforttuUon <br />~ <br />enemtu.d. eaKa on mr tngniry of the perwn oe per.om..t;o m.n.~e use sr.tem, .. S <br />~ ~ .,"'" <br />_ <br />~~ <br />~ <br />~ ' <br />~ <br />. <br />.. <br />f or these persoro dlrecty roporniEle for ptherin~ the Inforrrutlon, the informsUon T <br />•~ <br />~ <br />t,..,. A"~. «~ <br />'t <br />' <br />' <br />~ <br />' <br />f <br />'~' ' ,t <br />' <br />y ~ t ' ~~ ~ ~ . <br />~ , <br />1 ! "~« '" ~ Y ' ~ wbrirlltcd b, to the Ant of rrp knowkd~e snd belief, Irne, sceunte, end complete. <br />t <br />deunt <br />Inf <br />I <br />Ih <br />t Ih <br />itb f <br />D <br />lltl <br />N <br />tl <br />f <br />810NATURE OF PRINCIPA EXECUTIVE .~ ., <br />..' <br />; i,. <br />~, ~ <br />~ ,, i ~ <br />.,/.- ~ ~, . <br />? <br />% ' , p <br />em eweR <br />e <br />lR eR 7 <br />ptns <br />m <br />e <br />orms <br />on. <br />Of lY <br />n~ <br />fJ <br />' <br />TYPED ~ RINTED Indndin~ tirc posslbiutr of nne snd Imprisonment for knowln~ rldstlotr>. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO - DAY <br />COMMENTS ANO EXPLANATION OF ANY v10~ATIONS, lRd~rtinc~ eN ~tt~cninrnts htrr~/ <br />.:~ !~ 'x ~~71+' 4.TY..~ ;J .~. ate.: i ~l .L I i:.:i .1.. Z ~~l .1~. ~.' ~ :~ ~. ~' -.- ~~ ~` ~' t ; I. Jv ` Y ! ~ ~ d ~ ' ~' „ ; ` i7 .... 4c j' +'1 <br />KI !~. i~4 A .1 a C~~ .G. . A% • _ . j. <br />' I <br />EPA' Form 3320-1 (Rev. ~9) Previous editions maybe used. 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