|
.{M1~IT~E1'1A~IQ.I~~$!)rnlwMl~«•Nlrj.~d[.~-,wa,nefhr/1(•n,nri _ .- -- ----
<br />• f~ ntTtnwy, V01.LAlfANT DyC-WIf1E IKJMIN/rT10M fYStE/i1(1YPOFS) Form Apgtpvgd.
<br />p18CNARGE MONITORING REPOR7 [DAtA1 CYMt3 ku 2t~14G0p4
<br />_'--f- t1i1• 7
<br />~~RMIT IIwMeER ~, ~
<br />~.~.~_~.
<br />--1 J~ ~
<br />~~ t' : ;.:.: ;: MO_NITORIMQ P~R1OD •. ^a ~: I`• I A N f3 I V -: R y
<br />~ fflCATlON WALI)B!+1 YEAR MO DAY YEAR MO DqY ~ .,.~
<br />~ T ~ ~ ~ I `- _~_ i ~ 3"1(~i ~ F3 V FROM _ i+ -; °~ ;-
<br />~=~ +'ra S I IY'=i{~sfVr M j'i!~ .i TO , ;f ~ ! 1: t} ? •!-I~nf~4-~ ' ~ t ?i ~>{ ~
<br />PAIRAM~TER HOTS Rwd 11>rtn~tlong QNon ~ tlNs brm.
<br />ouANTITY oR ~.OAI)M1G QUALJTY OR CONCFHTAATtoN No. ~~xcr ~„~
<br />' AVERAGE MAXIMUM UNIT'S MINIMUM AVERAGE ~ AMAlx8fE TYPH
<br />? t='ta MAXIMUM UNITS
<br />!;AMPLE t::= a ~ ~ -* ~ Iti• ~ it itch
<br />1 l +i ~tiil]c lyit.N' -
<br />,f~t-;i~,`. '^t'7Tf_rs~•,r,: ~ 8AMPl: -- i
<br />'I
<br />1fEl~SU1iEAiENT - • - - - -
<br />1 o0!a4~9 1. p ~ ~ r , __
<br />IAA ' r i ~!.. v r ~ it-IP-l+hflr R~}~'bHT Cl 9 tvCl~ itA
<br />' ° I:_ ~li'1J 4;f:?E!15~: SAMPLE emu- ~ .>. 1 - ; - -- -- _ - _.?i~'i3 - _ . 1 ~ ~~ `~•~
<br />~ ~~5a~r ,~ MBAalIR6ME1rT - -•~----
<br />fi ~ n ~ u t' fti ' +: ~ IF'tr~} ~` ~ {E 1 +, «. ! ~ .: y- - - -t - -- ~ _ . _ 1 r- .. * 1
<br />' I_C1W , I'~: C3!JS:)~.J ~ 1-A(. f{ SI1MPlE ~ ~~ - _ `+'1~11:L ~ ~; ~ f Jl~
<br />' T HRV TPtEA 7MFN7 t~LAN NiABUREMEMt ( D`~` ' '•`~' ~ ,, ~ ~' s u . ,~ . ~ .. ,„ ,. ~, '
<br />_ : F~.SdEN7 GR ~a~ vAi_U ~~ ~ !~ ~. rT .- ,` f _- ~~ -r`-s ( ~
<br />Y~, x:: Mcrr • -
<br />!'IL A-NU G•~t-/aL•T- SAINPL>: .: ~ 1.~-t; ~ '!(.~st..f
<br />~.r 15UAl t •t _ _. - - -
<br />MEASNRBli16kT
<br />-~ f __
<br />-~..
<br />VA r` ~'1!~' 'yS(;.` i~ s ~t' i.Y,$~: 41'k'+lFM46~K- ~1• •IFiF~AFie'3i b6 .Jr#er1h~F itit-9F ~L~~}']t,~ :~ n
<br />sAl ` - - - -- - - +-- , {
<br />- - - - -- ~ . - _ - - ' ~ ' f ~Pf 'f t-
<br />MEABURgMQNT ~ --- , -- . I
<br />} ~ ,.
<br />t ~PlRMIT 'r. f p~ ., ~'"v y~y; ~ ~?,t; ~ ;i ' ~ ~;, ~~,~; ;, . -
<br />NAMIEITITLC PR` J~ ~(~(R1VE g~ h imdx peualry of 4+a cart tbi. dn:,uce;eu aril ~!t aiJxhnur.:~ „ ~ 1_`•",, ___'`_'^-"-- --- _~ L~ - ' ,
<br />~tE v+rkt n,~ dl/h1,0r V rup[rvlHnO N rC[(1111fI+A'! Kilh c cy~Kl cIC71 ' r -
<br />~ichaxd A. Munson l~r~.xr~cduryur-:f,.~,.~,.r,n„~, a~ ~ TEI><P+fONE pA~ ,
<br />.ulvuuaxl !lasad ac fr+,galr Rrdrot .al e~uluxe tiu,nfixautipa, /} ,,/~ - -_ -. _.-- --_
<br />ViC@ rresident "n'^W"~S'~nXn~narwrwo.,Nro~flr..yo~~y.wti I t /'1 1 t •~
<br />> r!'E~ OR PRIHT'EQ I ' " " °•"'••,a ~c ugo,rcant pondt~ i~. ~ubm:rtarp fitsc u,futnau~,n. --- ~ T OPAL EXE 970 ~ ~' 33 ~U 0~ '~ .
<br />t .L+d.lalmr, tAt pc,sarD~t,ty ur tir.: err! rer.+~amnr:. 5u 4,,..v r TIRE OF Pfil#) C(fTmr . ~- 1
<br />~~ .4t ~ ! .RF!hT!!lA~ ;ti~ n ~• -- - - - '„ImKx,. OFFICER OR AUTHORI2Ep ApENT
<br />-~~----- _ _ '++ vgAR Mo DAY
<br />CLP EVENT SUH`-ECT Ta BURDEN DF PROOF" REGIi,tIkEMENT3 IhJ -'~
<br />_ r~tsrte~n.~a~~.~.: Mrs .. -
<br />
|