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NATIONAL. POI-I-LITANT 1�1,j F,!_ sySj,Ej.j
<br /> • Dil SCHARG( TORING REPORT
<br /> li-fj cnt�!.
<br /> PC.
<br /> INSTRucriONS
<br /> L1. Provide dates for period covered by this tepo'l in::paces ma.!o-i
<br /> 2. Enter reporte
<br /> d minimum, average and maximum vat ocs undo1 1,
<br /> in III its specified for each parameter at; typ"'I"iaie. !I,, :�,f —1--;in
<br /> is u"asterisks. "AVERAGE" Is average computed over xi,i,tal lia- I itw.,,,,-is
<br /> ad"MINIMUM"are extreme values obuerved dming the r(.1-i':a. p, •d.
<br /> 3. Specify the number of analyzed samples that ex(-,(!it thenv,,;,,• ramm?"m a,
<br /> LA TIT permit conditions in the columns labeled"Ni,. F
<br /> of$
<br /> J PERMIT NUMBER 4. Specify frequency of analysis for each puramt,I,:*i'!; (,!A., ",'C7" i:
<br /> (20.21) 122-23) (24.201 42FI-an i2a-iw 13o.3U lont to 3 analyses performed every 7 days.) Ifwitua.us �w., 0!0'."
<br /> 5, Specify sample type(114gahll or ,—hr. composite") as If fi.:rpi,twy wa�,cuatjrj�,Uq,
<br /> REPORTINO PERIOD: FROM 1 0 enter "NA".
<br /> [IT-Tr 10 TO JL 9 6. Appropriate signature Is required on botiorn of thi>;foon.
<br /> YEARE A— 7. Remove carbon and retain copy for your cco,,j,,
<br /> L I; MO A v YEAR MO DAY
<br /> 132-371 —,--1 8. Fold along dotted lines, staple and moll Original I" p, iti—I 1,,1. ..... .it.
<br /> (I card only)
<br /> QUANTITY (4 card only! CONCENTRATION 1 1 1,Flo IF L:W:y
<br /> le 1f
<br /> PARAMETER 130-4151 146-531 16+011 wit-it, I sa.4%) 46-031
<br /> SAM
<br /> MINIMUM AVERAGE MAXIMUM uNir$ MINIMUM AVERAGE MAXIMUM U141 TSrI PE
<br /> EX x
<br /> At A I-YSIS
<br /> if� (,C,1P)LJTT REPORTED It it * it It
<br /> 'RM1 T
<br /> CONDITION Is # R # ii It 9
<br /> T''t'v 10TAI F i REPORTED 41 It
<br /> !
<br /> PERMIT KG/[)AY
<br /> 0 it it 0 *
<br /> CONDITION it
<br /> L S:J S I'l —-------
<br /> T'�T REPORTED
<br /> PFRMIT _ � �
<br /> K /U'AY
<br /> CON CI TIOH If fir
<br /> 30
<br /> 0,T A 1- A c� F.7) REPORTED
<br /> PERMIT 'y
<br /> CONDI TiOU
<br /> 5 7.-i
<br /> i L r) REPORTED d
<br /> IF 0✓ i i
<br /> it
<br /> SU
<br /> PERMIT 4 It It
<br /> CONDITION 0 It
<br /> At- REPORTED
<br /> P E to,I IF
<br /> CONDITION It
<br /> REPORTED
<br /> CONDITION
<br /> uEpo-IrED
<br /> PERMIT II
<br /> CONDITION
<br /> NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF THE OFFICER DATE
<br /> I Certify that I am familiar with tho infoonation contained in this
<br /> J.
<br /> report and that to the beat of my knowledge and belief such info,-PR F—s i i),—:,,v r J,
<br /> C,=/ O jr - -_ tt
<br /> mation is Into, complato,and accurars, nF PRINCIFIA Erxrc Tlve
<br /> LAST MI TITLE --- YEAR
<br /> F`ICCfI OR AUTtjGRjZCf1 Ali!
<br /> EPA F33'.0-1(10.72) 1
<br /> PAGV OF
<br /> ORIGINAL
<br /> ,,)I V PRI'-,aTPO YOrt D1'5TR1H(JTE:L) A W�A RM"OFF FROM COAL PREPARATI(JIN PL
<br /> AH T CANNOT EXCEED 4--7*, MG/L FOR TSS
<br />
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