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_ f <br /> % NATIONAL POLLUTANT 'HARGE ELIMINATION SYSTEM ,- <br /> DISCHARG ITORING REPORT m Approved 11 <br /> r I'`•'1—�T C'1�,1_ (PPI-P PLANT <br /> INSTRUCTIONS <br /> Y <br /> i ;•�l 81623 1. Provide dates for period covered by This report!n spaces marked"REPORTINO PERIOD". <br /> $. Enter reported minimum, average and maximum values under"QUANTITY"and"CONCENTRATION" <br /> u•aI a-let ur•Isl in the units specified for each parameter as appropriate. Do not enter values in boxes containing <br /> — — asterisks. "AVERAGE" is average computed over actual time discharge is operating- "MAXIMUM" <br /> and"MINIMUM"are extreme values observed during the reporting period. <br /> ♦tr! <br /> {M� [ST <br /> 7��OJ9', i. qw- <br /> 3 Specify the number of analysed samples that exceed the meximuro(and/or min/mlml as appropriate)permit conditions in the columns labeled"No. Ex." if none•enter"O". <br /> PERMIT NUMBER Dili LATITUDE LONGITUDE 4. ecif fre uenc of anal sis for each arameter as No. anal ses/No. de. s. e. "3/7"Is a iva- <br /> ,• .Specify frequency Y P Y Y ( Q•. W <br /> lao-tu laa•an larael 426•27I•lae•aYl lao-all tent to 3 analyses performed every 7 days.) If continuous enter"CONT." <br /> I ' S. Specify sample type("grab"or"—hr, composite')as applicable. If frequency was continuous, <br /> sorer "NA". <br /> , <br /> i REPORTING PERIOD: FROMW8. I O (,1 TO 9 ��'1" 0 1 6• Appropriate signature is required on bottom of We form. <br /> 7. Remove carbon and retain copy for your records. <br /> MO DAV YEAR .NO• dAY E. Fold along dotted lines, staple and mail Original to office specified 1n perdL <br /> na•an re+-en leo•TOI <br /> ` (3 card only) QUANTITY '. (e`are°nty) CONCENTRATION FREQUENCY <br /> PARAMETER Ise•+m IN-cal ' - Is+•en we.-aai roa•+aI IN-sal Isren /ez-aa DF SAMPLE <br /> _ MINIMUM AVERAGE MAXIMUM - UNITS NO. MINIMUM AVERAGE MAXIMUM UNITi HX• ANALYSIS TYPE <br /> F-1 ;)1i .I Id C0:'1')UjT R¢PORTEO 0 /00 3�0 It If 0 # 1F. IS p A A p if IS it ? (� <br /> MG0 MGD <br /> PERMT <br /> cONDlTliol+ 1/7 IN <br /> 1 �LiFoSo T()TAL DISS REPORTED A A A G A p A # # A # # 1t q # # Z�0 # p #' Y O (lqo GR• <br /> C-I ;F, +LVf-1)) KG/DAY MG/L <br /> 1 CONDITION <br /> coNolnoN A M A A • It k # A A # k N # 11 1► if # A A p # A # <br /> 1/90 GR <br /> iLlI )S, TOTAL SUSP REPORTED A tt ' M O A N A IS O 114D CO <br /> fi (;11�FrIvi)F0) PERMIT T KG/DAY FIG/L <br /> CONDITION #. IS A # # N 30 1/90 CO <br /> ?OpogTOTA(_ (AS FF) REPORTED A A A 1F tF A k e p A A +► IS # a p 0.71 0-71 0 1/cl Co <br /> PERMIT KG/DAY MG/L' s <br /> CONDITION ;► * A q p * M q i+ N A A # # +► 3e5 7e0 1/90 CO <br /> F',4fl•It-•L1; REPORTED * A A A * A IS 1t M A # A R.Z Q (' fO ag <br /> PERMIT <br /> SU SU r� <br /> COND TION * A A N A A * A 1f A N bap i1 # #- A 9e0 1/90 G(t <br /> fL 6 G-;FA5E0ISIIA REPORTED A A N iF 11 0 1t M tt A 0 Y * # M /F p # # M C> � (/qQ V <br /> � - CONDITION # A •PERMIT <br /> • IS # p A ♦i # 1F # #' fi p # q 10 t�- 1/90 VI <br /> R19PORTUD <br /> PERMIT <br /> 4 CONDITION <br /> REPORTED <br /> !j PERMIT <br /> CONDITION <br /> NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF THE OFFICER DATE <br /> �,' I certify that f am lamlller with the Inlormatlon coots/nee in this � yKdlat� <br /> ` ,ljc`J .IC>N'll� A I'►.t�u 10c/V)"' 178 report and that to the beat of my knowledge and belief such Info& <br /> oration Is true, complete,and accurate. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> LAST FIRST MI TITLE IYEAR MO DAY <br /> OFFICER OR AUTHORIZED AGENT <br /> 1 1 <br /> ? EPA Form 33I0.1(10.71) PAGE OF <br /> P04 IS SETTLFD I11NF WATER FROM DUTC H CRE-EK ANY SINGLE GRAB CANNOT EXC <br /> a FED 45 MG/L FOR TSS <br />