|
FormArpretr,', r
<br />FINTIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM f~PL~i=,SJ UMB N~. 2(k17-OOD4 ~~
<br />DISCHARGE MONITORING REPOP,T (DA~Aj
<br />4 e _ ~ (. ,
<br />~,
<br />I PERMIT NUMBER DlscEaRCE NuMeER =~ - 1 ','... ~__
<br />I,
<br />.. ,.
<br />MONiTQRiNG PERlOG I
<br />_.,~.
<br />Ytnr~R k~iC.. DAY_ YEAR MO... DAY r~ .. _,.
<br />FROM I L" TO -. ~ ;, -,: ...'
<br />NOTE Read Instructions before completing this farm.
<br />
<br />~'
<br />~J7
<br />N
<br />N
<br />v
<br />rNi
<br />a
<br />a
<br />N
<br />w..
<br />U
<br />z
<br />z ,.
<br />z
<br />w
<br />c
<br />m , -~
<br />~ ,.
<br />C~
<br />~.
<br />.~y
<br />x
<br />iil l~~l.
<br />I, ,:
<br />s. d
<br />I
<br />
<br />PARAMETER I QUANTITY OR LOADING QUALITY OR CONCEtJTRATION Np, FREQ
<br />UF NCY SkMPLE
<br /> EX O HYPE
<br /> ANALYSIS
<br />j AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />;i_i .SAMPLE , r: ,.:. w :, „ dt r ~ ., . i 't. ,.' i
<br /> MEASUREMENT
<br />
<br />- _. _
<br />, " " . PERPA6T -
<br />
<br />-
<br />
<br />,
<br />#''" ..#).~ - _ ~~ .~.~ n'' >d _!~ RIrOUIR~~IENT s. r F r. ..~
<br />' • ~- SAMPLE ~ '~" ""
<br />
<br />"
<br />' •
<br />'_~-~. t t "`' MEASUREMENT ~ I '
<br />©~ , 3
<br />~V
<br />~u
<br />~ ~F#$IiIT _
<br />.,t-o °Y' 4 1L1~ `/~![,.L{h REOUIR~E"~[ENT ..~-n ~
<br />
<br />..
<br />
<br />. a
<br />'
<br />-
<br />i
<br />
<br />
<br />~
<br />-
<br />
<br />,
<br />
<br />,,.~
<br />EiS.
<br />
<br />
<br />~
<br />
<br />.
<br />_.,~ ,,. ~'.: s{.. _. _>..,:.
<br />.. SAMPLE
<br />
<br />~.
<br />`~::a' r.
<br />
<br />- .-
<br />.f -_
<br />,.
<br />...w .,,
<br />,>,...-~ `_' ,
<br />
<br />~.
<br />,.
<br /> MEASUREMENT
<br />
<br />' •rl
<br />~; _ ~,u .~~; ..,1_.~ -:.
<br />- -
<br />.., ... ~ : ~~:. REOUIR~NENT
<br />
<br />SAMPLE
<br />_ - ~
<br />_ f ~... ' ~.
<br />
<br />( .~ ..; r
<br />.:.
<br />w: is x.
<br />MEASUREMENT
<br />,.,., r
<br />~~- PERMIT
<br />,~r
<br />n ,
<br />Cr'r"I_`~~.(+..; x~i?_;G~ `W..._'~%L; RE{pUIREMENT
<br />
<br />,:,~ ...:
<br />
<br />..
<br />-
<br />_,
<br />~
<br />- ..
<br />
<br />i,:~t,. ~
<br />r'~~:/. ~- ~. ,i .F-;`- SAMPLE r ,..:. -~ _- . ,
<br />- ~ `"7E~; MEASUREMENT
<br /> ,~_,,
<br />r
<br />r r"'~ ' 6~ ° ~ rj ~ 'd ..-. _!I<' R1=QUIRE>~1ENT ., ., ~ i, ~ .; "i:.
<br />-, ~' + ~~~!: SAMPLE ...:,. _.. ~::_.. _ __,, ~.: ~ ..~_. ---+ --~., f
<br />
<br />MEASUREMENT l
<br />gyn., ~ PEAMkT , ,L, r~u ~.;.~ ,~
<br />~_t'~ j_t?`"' . ~ t.~_..' --%
<br />W _ REQUIREi~9ENT ,;
<br />
<br />~` ~ ! . __ ~
<br />
<br />;
<br />, r.u~
<br />k
<br />.s
<br />,, ...
<br />s `i;. : i~ + Ir t r ~ ~•r SAMPLE
<br />
<br />
<br />MEASUREIV1EfJT , ..
<br />, ,
<br />.. _. _. ~, . „ .~ s:;
<br />sr ~',,..~ ..
<br />~ ~,a ~~ .r ~
<br />
<br />- ~ ~ y , -
<br />
<br />PER,Ntt`f
<br />
<br />~
<br />- .,.. _ ....~ .
<br />-.,
<br />~
<br />;
<br />~
<br />_t , .. .,~ _. ~ t .,'~_ :: ~ ,.'~ ' REQUIREN}ENT ~ ...,- : , ~~: ~.~ L.' .~ ~ ~
<br />i ~
<br />1 -~ ~ ~
<br />`
<br />~~ ~i
<br />I
<br />NAMEl1'kTLEPRINCIPALEXECUTIVEOFFICER lcerneyanderpe~aufotta~rrhatthisdoeumentandanattarhment5nare .-_
<br />TELEPHONE _
<br />DATE
<br />/2~ ~r
<br />W
<br />~ prepared under my direction or supervision in accordance with a system designed
<br />ik'#qrv Vt~'
<br />h, [o assure that qualined personnel properly gather and evaluate the information
<br />' submitted. IIazed on my inquin~ of the person or persons who manage the system,
<br />~ n or (hose persons dkeclly responsible for gathering the information, the Information
<br />
<br />`, /#/ ~~~.~~)
<br />v
<br />submitted is, fo the hest ofmy knowledge and belief, true, accurate, and complete.
<br />1 am a4vere Th
<br />t th
<br />if
<br />i
<br />l
<br />i
<br />NAT E 0'r PRINCIPAL EXECUTIVE
<br />~7~ ~/p
<br />`~l~'~ Y ~ .n
<br />7A
<br />~ r~
<br />f
<br />
<br />TYPED OR PRINTED a
<br />ere are s
<br />icant pena
<br />gn
<br />t
<br />es for submltting fate informaton,
<br />indudingthepossibilityoffineandimprisonmentforknowingrioladons.
<br />FF ER OR AUTHORIZEDAGEN7
<br />AREA
<br />NUMBER
<br />YEAR
<br />MC
<br />Dp
<br />Y
<br />.,...,.a,,.,_,...,,. _.._...,._.,.., ..~ ..,,,,.._. ._._.._ ._ CODE .
<br />
<br />
<br />~1 ~~~~
<br />`''II II
<br />~~~'1
<br />~'
<br />t" ~li
<br />.~
<br />i! ~',~'~
<br /> ~. .~ .+ r . ~ {rresercrra,e err auacnnrenw here/
<br />-
<br />_
<br /> _
<br />
<br />
|