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NATIONAL POLLUTLN16,1APG ELIMINATION SYSTEM E - <br /> - 1 1'•�APproved <br /> DISCHARGE muNITOR NG REPORT <br /> ! OrV B NO.I SE-1t0073 <br /> 1 <br /> r lh irl r r- CoR - 644 C 619tsIV M iNE �s <br /> P4 Box l$$ <br /> C�4128�A/QY9'i INSTRUCTIONS <br /> 1. Provide dates fir period covered by this report In spaces marked"REPORTING PERIOD". <br /> J 3. Enter reported minimum, average and maximum values under"QUANTITY"a:d"CONCENTRATION" <br /> in the units specified for each parameter as appropriate. IDO not enter values In boxes containing <br /> Ib91 u•Iel tn•i°! asterisks. "AVERAGE" Is average computed over actual time discharge In operating. "MAXIMUM" <br /> and"MINIMUM"are extreme values observed during the reporting period. <br /> C O dOZ 3 7 5'.2- H /Zf 3. Specify the number of analyzed sompiea that exceed the maximum(andlor minimum as appropriate) <br /> �� �AT permit condition°In the columnslabeled"No. Ex." if nose,enter"O". <br /> r ST PERMIT NUMBER SIC LATITUDE LONGITUDE <br /> 4. Specify frequency of analysis for each parameter as No. analyses/No. days. (e.g., "3/7"is equlva- <br /> ` Im-tu Izs•:n tta•zm Ixe•zn I2e•z91 (w•aU _ lent to 3 analyses perfomied every 7 days.) If continuous enter"CONT."S. Specify aample type("grab"or"_hr. composite")as applicable- It frequency was continuous, <br /> enter •NA". <br /> REPORTING PERIOD: ik04 TO O <br /> ml <br /> ^^^///���ho <br /> •f AR MO DAY) 6. Approplidie signature is I-qufred On bottom Of this fo - <br /> / dl <br /> YEAR DAY YE 7• Remove carbon and retain copy fur your records. <br /> S. [void along dolled lines, staple and mail original to office specified In permit. <br /> lee-sat le°••rm <br /> �ww (a`s`d OR)y) OUANTITY (4 card Orly) CONCENTRATION - FREQUENCY <br /> j i3B-+v Ib-sal 10+ell le]_0.0.11ae•tel IC!•e91 lee-ell_ (et-ea OF SAMPLE <br /> PARAMETER — NO. <br /> MINIMUM AVERAGE MAXIMUM UNITS EX MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPa <br /> REPORTED - <br /> . <br /> FERMI <br /> rqi CONDITION <br /> l <br /> ± REPORTED --_- <br /> it <br /> PERMIT <br /> CO N 131110N <br /> i REPORTED <br /> N <br /> i qY� PERMtT <br /> '17 CONDITION <br /> } REPORTED <br /> '.� PERMIT <br /> CONDITIONI <br /> REPORTED \\\t <br /> PERMIT <br /> CONDITION <br /> t REPORTED . <br /> I <br /> PERMIT <br /> 'j CONDITION <br /> REPORTED <br /> PERMIT <br /> CONDITION <br /> REPORTED <br /> PERMIT <br /> ;! CONDITION <br /> NAME OF PRINCIPAL EXECUTIVE OFFICER 'v TITLE OF THE OFFICER M DATE <br /> --- — !cerllly that I am familiar withfhe information contained in this �ef <br /> ' _ L),_ report and that to the beat of my knowledge and belief such Infor '�� (J1 <br /> d ��V-S -kd�t/ �Xf GTI/ic ���1L r=^ 1 , !AAY <br /> metlan is true, complate,and accurate. SIGNAT RE OF PRINCIPAL EXECUTIVE <br /> LAST FIRST MI7i"iLE YEAR MO OFFICER OR AUTHORIZED AGENT <br /> EPA Form 3320.)(10.72) PAGE OF <br /> ORIGINAL <br /> Y - . <br />