a
<br />
<br />,,~
<br />,~JJ
<br />1~~1~~
<br />N
<br />v
<br />0
<br />a _~:
<br />w
<br />0
<br />LL
<br />0
<br />z
<br />z
<br />a
<br />z
<br />z .-~
<br />o;~ ;~ ;
<br />j . ~,
<br />~.
<br />!1~;~
<br />rvnu npNmeea
<br />F1AT!GNAI. POLLUTANT DISCNAAGE ELIMINATIGN 5/STEM ((NPtrE'Sf Oit~D P10.2C+s~ ~G4
<br />DISCE~ARGE MONITOR'NG REPORT (aMRj _.-.
<br />;, -- - ~ ;
<br />_; w _.
<br />PERMITNUMEER ~ DISCHARGENUMBER ~~
<br />MONITORING r~ERIOQ _
<br />FEAR MQ. DA,:Y YEAR MO.. Dal .. " . _. _-_ , r
<br />FROM TO NOTF;~Read lnstructionsty~
<br />_ before completing this foam.
<br /> NtJ FREQUENCY S~MPLE~
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION , OF
<br /> EX TYPE
<br /> ANALYSIS
<br />., AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />~t ~ t 'SAMPLE I ''~r,~..,.._, t4 t a . __:. ;fir ~-'- .try i
<br />
<br />r` ~ ~;.!:;;._ . ~ u
<br />MEASUREMENT t
<br />D ~
<br />InO.f
<br />
<br />.,,.,
<br />
<br />,;
<br />
<br />_
<br />~ .:
<br />
<br />
<br />
<br />S>gtu91T ---- -
<br />
<br />
<br />s
<br />-
<br />
<br />._ --
<br />r
<br />
<br />~
<br />
<br />r ,
<br />-
<br />ref t.t~~+,, ~,~cLa:_w. ~,~.` ;r REQUIF~~ME,UT
<br />:.
<br />~ ~,.,:. f{I~f~`;_ _ e
<br />tit' 1 n
<br />'-l =' ~, -; ~i ~:r, fi .
<br />SAMPLE ^~~.y~~.
<br />.- ~ _ ~'
<br />, ; i': ;t .. .,..
<br />- '~S'7i ^r'rfi_
<br />'"'^ •Rfi:i'., _
<br />:Fi ~ I ^st. MEASUREMENT
<br />;fit' ~'`,' ~ '-° PEAfi~IT - -- i
<br />~ •;bt'r~ , ,; _ _ ,-i
<br />w:W~!~~.ir:;~,'r `i.~..~:.~ ..:~__:. REQUIR~JIENT
<br />_ +
<br />sl `
<br />~ w.,rx~.., i .'
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br />PERMIT _
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br />~ ~I
<br /> REQUIREMENT I . :~~
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIR~MtENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIR€MENT
<br />-
<br /> SAMPLE --- ~
<br />I
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAMEfiITLEPRINCIPALEXECUTIVEOFFICER rcerlifyunderpenaltyofla+rthatthisdocumentandallattachmentsaere TELEPHONE DATE
<br /> re ared under m ~ f n u en~sioo io aaordance+rith a s stem deli ned
<br />dmat o ors v
<br />P P } P 8
<br />_
<br />1I
<br />~aM ~,~~ r,
<br />~a {l
<br />t~ to assure that qualified personnel properly gather and evaluate the informaNoa
<br />e submitted. Based on my inquiry of the person or persons who manage the system,
<br /> or those persons directly responsible for gathering the information, the information
<br />
<br />t
<br />t
<br />b
<br />i
<br />d i
<br />l
<br />d
<br />db
<br />ti
<br />F
<br />d
<br />l
<br />h
<br />~
<br />~
<br />O ~y
<br />~~;A''~J
<br />~ aue,accura
<br />e,an
<br />etc.
<br />su
<br />m
<br />tte
<br />s, to t
<br />ebesYOfmpknos+
<br />e
<br />gean
<br />e
<br />e
<br />,
<br />comp SIG ATUREOFPR!NCfPALEXECUTIVE ~ I ~~
<br />~ `~'
<br />l
<br />TYPED DR PRINTED t am axaretbal there are significant penalties for submitfing false inforntatiou,
<br />including the possibilityoffine and imprisonment far knowing violations. FFICER DR AUTHDRIZED AGENT AREA
<br />CDDE NUMBER
<br />YEAR
<br />MO
<br />'DAY
<br />,, k : arracnmenrs nere~ ,
<br />..
<br />,.... ~ ,
<br />..... J ~ . _ , . , ~' -
<br />y,.,.y.
<br />~~ '~~ r!
<br />~"yh~+
<br />~-
<br />
<br />r~~~~~.
<br />~.
<br />II''I
<br />~~~i /1 t1
<br />`.
<br />,;~
<br />4~. I,~,
<br />et
<br />:~
<br />'''~
<br />
|