|
,,r
<br />I '#
<br />t J, 1 ~~ I
<br />a
<br />N
<br />N
<br />N
<br />°o ,
<br />N ~j
<br />W 33
<br />I
<br />~ u.
<br />c
<br />c~
<br />
<br />z
<br />n
<br />a
<br />z
<br />w ...
<br />z
<br />of
<br />~ ~. '
<br />R
<br />PERMITTEE NAMEIAGDRESS (InaludaFaciGr}.VmnelLacn(im~ J'D;}frer,t~
<br />roan ~.pproveo. ~~
<br />NA}'IOFdAI POLLUTANT DISCHARGE ELIMINATION SYSf°_M (l+ll'fJ~~) OPn61d0.2O40'OOG4
<br />D[SQFiARGf MONITORIPICa REPORT (Dn~Fs) ., .:
<br />-.- '~ ;~
<br />.,
<br />~... -
<br />~.
<br />PERRMIT NUMBER DISCHARGE NUMB_JR f r
<br />____ MoNiTOR~NG p~Rl~~ ____~
<br />YEAR MQ. DAY YEAR MC3., DA" - - ; ::~ <'~
<br />FROM TO i ; =,'- ~, ;<+
<br />NOTE Read Insttuctwns pefitare completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREQUENCY
<br />of SAMPLE
<br /> EX TYPE
<br /> aNAt.vsls
<br /> AVERAGE MAXIMUM UMTS MINIMUM ( AVERAGE MAXIMUM UNITS
<br />=;.ii k.. .a `;;_ °SAMPLE :~ y -`:., .: - _ y „ w r
<br />~
<br />~~~ ~ MEA
<br />MENT ( ,5G /'l!~ -
<br />`, .~.
<br />`~ PEAMI _, ; ~ i _~
<br />,-
<br />~ I
<br />. ', ~ ~~~
<br />~
<br />~~
<br />E~'?'L.t.~~a~~~ .;L~.",,~~ '„_..='' REOttIREMI~;~T t ,
<br />., ;
<br />~
<br />i~as~ ~
<br />
<br />.. ...
<br />
<br />pp
<br />r;
<br />... ,, _ ,~,_
<br />
<br />
<br />
<br />
<br />AMPLE ----~--
<br />.. -
<br />
<br />
<br />
<br />,
<br />'.
<br />
<br />
<br />
<br />.
<br />.,,.,....
<br />
<br />,,,s.
<br />
<br />
<br />
<br />
<br />.... A
<br />n.,~~,.
<br />tjs°1:tr ,. MEASUREMENT ~
<br />li f7 } Il ~ J P471MIT
<br />~ - 'C.YC i^
<br />4
<br />~t:'i ;_i 1 r ?' ('r Fe ' ~~%f:
<br />.. ... ,. ,. -.w ~- REQUIREMENT
<br />~ t tt
<br />.. ^^si ,. .
<br /> SAMPLE -- i
<br /> MEASUREMENT
<br /> PERMIT _- -
<br />I ~
<br /> REQUIREMENT _ ', ~I
<br />
<br />SAMPLE __. _
<br />',
<br /> MEASUREMENT
<br /> PERMIT ~ ---
<br /> REOUIREfvtENT
<br />
<br />SAMPLE --- -- -
<br /> MEASUREMENT
<br />-
<br /> PERMIT I r --
<br /> REQUIREMENT ~ I
<br />
<br />SAMPLE
<br />-- -
<br />-
<br />_ - ~
<br />- _
<br />~
<br />~
<br /> MEASUREMENT ~
<br /> PERf~IT
<br />~~ ~
<br /> REQUIREMENT - ---
<br /> SAMPLE ~
<br /> MEASUREMENT ~
<br /> PERPAIT
<br /> REQUIREMENT ~' ~ I '
<br />NAMEffiITLEPRINCIPALEXECUTIVEOFFICER icertfyunderpenaltyotlawt6etthisdocumentandauattachments++ere TELEPHONE DATE
<br />p I
<br />(s/ r,l~ Q,h C0.r rj i` prepared under my direction ur supervision in accordance wilhasystem designed
<br />to assure that qualiPed personnel properly gather and evaluate the information
<br /> submitted. Based on my inquiry of the person or persons rvho manage the system,
<br />
<br />1
<br />~' ~ ~
<br />~
<br />`~~~~ or those persons directly responsible Por gathering the information, the information
<br />submitted U, to the best of my Anowledge and belief, true, accurate, and complete.
<br />S NA RE OfPRINCIPAIEXECUIIVE
<br />'
<br />~j'jp l11ag -s~ eD y
<br />oU
<br />p
<br />Q'
<br />`~ a
<br />'
<br />`' Iamawarethnttherearesigoi[icanlpenaltiesforsubmitlingi
<br />alseinforma6on,
<br />P CERORAUTfiORIZEDAGENT E NUMBER YEAR MO DAY
<br />TYPEDQRPRINTED ~ including the possibility ofYmeandimprisonmentforknowing+dolatlons. COD
<br /> i
<br /> ~~~~~~~
<br />
<br />
<br />al TUNS (Heterence alt anacnrnents Here) ~ ~
<br />~_ _; ` .
<br />
<br /> .
<br />.
<br />.. -.-- - -
<br />.. ~.._ s__~ ~.
<br />.~ .._. _ ._ . r_.._ PArE =GF
<br />i~~
<br />~` -'
<br />
<br />-~~
<br />
|