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l 7i • - ' <br /> NATIONAL POLLUTANT Dry E ELIMINATION SYSTEM `� { <br /> 1 DISCHARGE ML ING REPORT � bred r <br /> i <br /> INSTRUCTIONS i ' ' <br /> t I. Provide dotes fur period covered by this rrport in space•marked"REPORTING PERIOD". <br /> { -J 2. Enter reported minimum, average and maximum values under"QUANTITY"and"CONCENTRATIONte <br /> In the units specified for each parameter as appropriate. Do not enter values in boxes containing <br /> la-s I.1w u7.191 asterisks. "AVERAGE" is averarc computed over actual time discharge is operating, <br /> "11ASD4UU"' + <br /> { and"MINIMUM" are extreme values observed during the reporting period •i ' <br /> CO �0003 Wtii CJ% /�( 3. Specify the number of analyzed samples that exceed the maximum(end/or minimum as appropriate) <br /> ' --- permit conditions In the columns labeled"No. Ex." if none, enter"0". i 4�F <br /> fT PERMIT NUMBER Oii SIC LATITUDE LONGfTUD6 4 cp T frequency Y p y y ( �,�•' / eqv/errr• ' •' <br /> eci( fro uenc of analysis for each ammeter es No. anal ses/No. days. a. 7"to _ <br /> lent to 3 atialyaea performed every 7 days.) It continuous enter"CONT." <br /> .► rm-zu Izs-wi Ize•ta t:e-zri /ae•zai lao-an g; Specify sample type(•'grab"or"_hr. componi(e")as applicable. It frequency Tres ContinuouM .» <br /> ? t -•-� _ enter •'NA". <br /> REr'ORTING PERIOD: FROM ! ! d j 0 TO ' 1 10 1-1 6. AP.ropriele sl g<IOWre la required on bottom Of this form. <br /> YEAR MO OAT YEAR MO OAY 7. Remove carbon and retain copy(nr yarn records, ![•` <br /> S. Fold along dotted lines, staple and mail Original to office eviecified is permit <br /> 1 Ta.Sri <br /> -- (3cardoniy) QUANTITY (dcudonly) CONCENTR4TION FREQUENCY <br /> -a PARAMETER Ire-es., lee-aN raaeH lea-all lea-sal 4e8-E11 te"Ib IaT•ef O/ IIAMPL� <br /> —j— MINIMUM AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM YN17t EX- ANALYSIS TMPH <br /> v IM1 <br /> RePORTHO •! <br /> E' <br /> COND.Flom 1 �. <br /> 'g REPORTED � <br /> 1 J <br /> 17 <br /> PERMIT CONITION A10 A sett • filr UU , & 9 l 06— P WAO ► <br /> i REP OR T60 �'' <br /> PERMIT <br /> RaPORTaO <br /> _ 3 <br /> PERMIT LL <br /> ► J; <br /> .+ CONDITION <br /> REPORTED <br /> pEFMIT <br />' COW,TiON ' <br /> -� REPORTED ..) <br /> tl PE—T , I <br /> i cONDI TION <br /> NEPORTclo <br /> e� <br /> PCRMIT <br /> i CON UI TION f t <br /> RaPORTCO <br /> C ON OI TION I: ' <br /> '{ NANO OF PRINCIPAL EXECUTIVE OFFICER TITLE OF THE OFFICER DATE <br /> --- t cattily that I am familiar w11h the inlotmatton contained It*Usle <br /> :i i/iGE P/S'E5iUEN/ report end that to the heat of my knowledge and(relief such Infor- <br /> CX/. CuT/VE <br /> 7 f a` motion to(ma, compfaflr and eeeuretw SIGNATURE 0/PRINCIPAL EXECUTIVE 1 <br /> 1 ,LAST FIRST MI TITLE YEAR MO DAY ORIG[R OR AU THORFZEO AGHMT <br /> EPA Par.3320-1410.74 PA66 of <br /> ' ORIGINAL <br /> i �. <br />