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NATIONAL POLLUTANT 1315(. GE ELIMINATION SYSTEM <br /> DISCHARGE t NG REPORT <br /> i <br /> k <br /> 1 f <br /> I� B <br /> t <br /> INSTRUCTIONS ; <br /> L 1: <br /> I. Provide dates for period covered by Ihfa report In spaces marked"REPORTING PERIOD". P f <br /> Ia-n <br /> 2. Enter reported minimum, average and maximum values under"QUANTITY"and"CONCENTRATION" 1 'rs-Im IrT-u,l in the units specified for each parameter as appropriate. Do not enter values in boxca containing 1. <br /> asterisks. "AVERAGE" Is average computed over actual time discharge is operating. "MAXIM UM" . <br /> i CO 075-OYR-i-00028 0 t o =17'3�8" <br /> and"MINIMUM" are extreme values observed during the reporting period 5.. <br /> 39 11 52 3 specily the dumber of analyzed samples that exceed the maximum(and/or minimum as appropriate) <br /> STPERMIT NUMBER p18 SIC �LA TITU DE permit conditions in the columns labeled"No. Ex." If none,enter"O". <br /> 4. Specify frequency of analysis for each parameter as No. analyses/No. days. (e.g-, "3/7" 1a equiva- S <br /> Ito-2u In-zi) Ia.-ala 126-27t I2e•xvI 13o•3U tent to 7 analyses y days.) V'. <br />! S. Specify sample type(�`grab't ore' 9 hr. composile")as appilcable�If frequency was continuous, <br /> t enter 'NA". Fp <br /> REPORTING PERIOD: FROM _ TO _I 6, Appropriate signature is required on bottom of this tomb <br /> i YEAR MO�DA YEAR MO DAV T• Remove carbon and retain copy for your records, t <br /> 1111 <br /> 132.311 8. Fold along dotted lines, staple and mail Original to office specified In permit f.aaesl lea•Tm(9 card an/y) QUANTITY (4 G1rd truly) CONCENTRATION <br /> PARAMETER i3e sm Ise-esl _ Iss-eU m2-em 13e•4s1 Ise•sat' lerau re2-s3 FREQUENCY SAMPLE <br /> MINIMUM AVERAGE MAXIMUM UNITS EX _._. MINIMUM AVERAGE MAXIMUM UNITS NO OF TYPE f <br /> EX ANALYSIS <br /> REPORTED _ !t <br /> PERMIT -- 1- <br /> CONDITION , <br /> REPORTED <br /> PERMIT I' <br /> 1 CONDITION <br /> REPORTED <br /> NO TEPORTED DISCHARGE DL RING RE OR.ING PERIO <br /> PERMIT L. <br /> CONDI TION <br /> REPOR TEU <br /> i, <br /> PERMIT <br /> 1 <br /> j CON UI TION i <br /> C- <br /> REPORTED j <br /> P ERMIT - - <br /> REPORTED <br />} PERMIT -- <br /> COIIDI TION <br /> REPORTED <br /> i <br /> P E RMI T ---_ --- —'—' __ <br /> CONDITION 1 <br /> it <br /> REPORTED _— <br /> I <br /> CONDITION <br /> _ <br /> NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF THE OFFICER DATE <br /> —" I Certify that I am familiar with (tee Information contained In this o' - '• f, <br /> J. A. Reeves xecutive Vice President 7� 6 1 0 3� report seta that la the bast of my knowledge and balls(such inlor <br /> oration is true, complute,and accurais. 111HATURE OF PRINCIPAL EXECUTIVE j LAST FIRST MI TITLE YEAR MO DAY OFFICER OR AUTHORIZED AGENT <br /> EPA Farm 3320-1(10.72) PAGE. OF I <br /> ORIGINAL <br />