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NATIONAL POLLUTANT 0!'CHARGE ELiMINA I ION SYSTEM <br /> DISCHARGE 'JORING REPORT <br /> NL,, I ti3 <br /> r <br /> INSTRUCTIONS <br /> L1. Provide dates for period covered by this report in sPacs nNoh:J"REPORTING IIF <br /> 2. Enter reported minimum, average and maximum villllvi3 onlier"QUANTITY-and"CONCI:Wl"RATION" <br /> 12-31 14-14) in the units specified for each parameter as opp"'Ptiale. r),l'w,I eni- v.1ul-:;ill 1,-- <br /> asterisks. "AVERAGE" <br /> AVERAGE" is average computed over a(:to-I tilri,! Ili;11—rl i:; -1-latiog. <br /> 1211 and"MINIMUM"ereextreme values observed duriog the rcil-i� r 1--J. <br /> Specify the"'Ther f analyzed samples that ex--i Ihi� .......ini".on,a, <br /> sic LATITUDE permit I conditions in the columns labeled"No. Ex." it tillele, <br /> [D�I-SJ 4. Specify frequency of analysis for each puranwie"ai;No. <br /> (20.211 422-23) 124.2ai 426-27) 420-201 450-411 tent to 3 analyses performed every 7 days.) If c-ition--cot, ONT.11 <br /> S. Specify sample type("grab"or"—hr. compositell)or. appli,;-i,lv. If frequency Was Continuous, <br /> 7 enter "NA". <br /> REPORTING PERIOD: FROM TO 9D 1 110 6. Appropriate signature to required on bottom of this form. <br /> 7. Remove carbon and retain copy for your records.YEAR NO MO R, It. Fold along dotted lines, staple and mail Original to office sperlfiorl ill pv"nit. <br /> v (3 c-d only) QUANTITY (4 card..IV) CONCENTRATION <br /> PARAMETER (46-031 (04.0 IT (62-63 130-431 154-011 .6 1: Sn1eP LE <br /> of <br /> -T ANALYSIS <br /> NO. <br /> MINIMUM AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM AN ly <br /> EX, U"' 5 <br /> REPORTED O. 041Z it If At <br /> MG D <br /> P ERMI T D <br /> ON Ul I ION It <br /> I-) 1' IT 01:-S REPORTED 0 # It # # It C.), <br /> L Il E i)) <br /> PLKIJIT KG/DAY <br /> CONUI TIO it # # # # R # # # # # v # # # # # # # It "U <br /> REPORTED <br /> F) <br /> KG/DAY <br /> PERMIT It It it <br /> CONDITION 30 <br /> 1 0 T A A S F REPORTED # ii # It # # # # # 0-oZ <br /> (A <br /> KG/DAY 'i, /L ------- <br /> PETo.o T <br /> CONDITION <br /> 5 7*, <br /> REPORTED It Or 7.5 It 0 If <br /> At <br /> Su ------ <br /> PERMIT <br /> CONDITION 6•0 <br /> REPORTED it tt # # # it <br /> P E fe.l.T <br /> COND,TION it # $1 It <br /> if If # # # # # V1 <br /> REPOR CONDITIONTF6 <br /> P L Plo'f <br /> REPORTED <br /> PERMIT <br /> CONOI TION <br /> NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF <br /> certify that I am familiar with the information contained in this THE OFFIC!�R GATE 'D i7-;3 iPEN 7- report and that to the beat of my knowledge and belief such infor.. <br /> MI TITLE YEAR MO )AY- motion in true, complete,and accurate. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> LAST <br /> OFFICER OR AUTItORIZED AGENT <br /> EPA F.r.3320-1(10-72) <br /> PAGE OF <br /> ORIGINAL <br /> 15 S(`!'TLFD MTIAr WATER FRDM L.S. Wo0f) MINE 43 ANY SINGLE GRAB CANNO <br /> T EXCi-717t) W; !'G/L F(iR TS5 <br /> 4 <br />