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NATIONAL POLL UTA t��HAFIGE ELIMINATION SYSTEM - • I <br /> DISCHARGE MONITORING REPORT corm Approved <br /> OMB NO. 158-RO073 <br /> 9 I <br /> r rA1 p --CT COAL- 13EAR cR w'11 E <br /> Pe <br /> CCU Fi'16 L3 INSTRUCTIONS <br /> 1. Provide dates for period covered by this report in spaces marked"REPORTING PERIOD". <br /> ,j 1. Enter reported minimum,average and maximum values under"QUANTITY"and"CONCENTRATION" <br /> u•a u•Im ;1'n IaI is the units specified for each parameter as appropriate. Do not enter value-in boxes containing <br /> uterlsks. "AVERAGE" is average computed over a•-'ual time discharge is opersting. "MAXIMUM" <br /> and"MINIMUM"are extreme values observed dd ang•`!,e reporting period. <br /> CO p 0-L 3.7�Lf aO f /2I 1 3. Specify Ills number of analyzed samples that exceed the maximum(and/crminimum as appropriate) <br /> ST PERMIT NUMBER DIS SIC LATITUDE LONGITUDE permit conditions In the columns labeled"No. Ex." If none,eater"O". <br /> 4. Specify frequency of analysis for each parameter an No. analyses/No. days.(e.g., "3/T' fe equlva- <br /> .! Izn•su _Its-zn I:aam Iza•x71 Ize-:al lao•au tent to 3 analyses performed every 7 days.) If continuous enter"CANT." <br /> S• Specify sample type("grab"or"—hr- composite")as applicable. If frequency was continuous, <br /> enter "NA". <br /> REPORTING PERIOD: FROM - I TO 7 6• Appropriate signature Is requi:cd on boitnm of(his form. <br /> — n In co records. <br /> - <br /> •'I VEAP. MO DAY YEAR MO OAY 7• Reme va along <br /> dot end res copy for year <br /> S. Fold along dotted lines, staple and mail Originnl to office specified to pe:mit. <br /> 1.+•66l (OR-701 <br /> (3 ama°nly) QUANTITY CONCENTRATION FREQUENCY <br />��- PARAMETER lee-mI Lea^al le.-en a�Oa las•+sue iae_e3� Is.-eu_ laz•ea _ OF — bAMPLE <br /> MINIMUM AVERAGE MAXIMUM UNITS EX M!!IIMUM AV 2FlAGF. MA y.i MIPA UNI"iS Ex• TYRE <br /> 'A q�f ANALYSIS <br /> 1 Ftooj 2A47•E REPORTHO G a 1' L 07, --__ _ Co A;7- <br /> W pp� ty J C a N►h JJ y p CU 1116.t P-SI/AY PIRMiT '1 C.(J /D <br /> CONDITION <br /> IELQ REPORTED S-3 <br /> P!f. F -- 50 50 ---/C— -- <br /> -:1 PEHh-IT <br /> 406460 CONDITION 6 �� ---- - --- <br /> 4120AI 167-AL Fe RxPORTEO x a o.22 - Q-3 3 to <br /> .{ ItoFENI.11 T �-Aordy <br /> I0 IV 1 CONDITION •— -` 'y <br /> rS0414 r . 707-AL RFPORTEO <br /> �•✓s / � LJ PERMIT �tY� • 3l� <br /> 46-7 <br /> oQ 53� ter•C$ CON JITICN -__ )o —__ <br /> 0/ �'Ca./2l-A SE REPORTED 41 a- r�• `-J /'l <br /> !1` � '; C+-1Z <br /> 1 • ^ .�rL� PERMIT •ter l O �/C� 6-i CONDITION <br /> 7Vl�.iUI A/I/ 1 REPORTEn 01 /23. , ✓.14 -- / �f�A —ate <br /> 1 I PERMIT J+— TO V <br /> 3C) 3/6Y &Ae <br /> CONDITION JV <br /> REPORTED <br /> i <br /> PERMIT <br /> I —CONK,TION <br /> 11 -- <br /> REPORI'En <br /> PERMIT <br /> i CONDITION <br /> _ NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF THE OFFICER DATE <br /> 1 I certify that f am familiar udth the information contained in this U tom ! <br /> _ report and that to the best of my hnonledge and belief aurh infor- <br /> A r-sccur[f/c wail 1-V1,;:51fh61V 1 malion is true, wmplete,and accurate. siGNktuNE OF PRINCIPAL EXECUTIVE <br /> LAST FIRST MI TITLE YEAR MO DAY OFFICER OR AUTHOrNZED AGENT <br /> EPA Form 3320.1(10.72) PAGE OF <br /> ORIGINAL <br /> it <br />