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.1. , : F F NAME ADD1-E`1 <br />NAME <br />ADDRESS <br />t x _E C0 <br />FACILITY nl I NZ- <br />LOCATION <br />L.N GO <br />Ui.-,k,, lAHUL MON110 iING HEPUK (biVik) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />('I15H ,JC ) <br />F - FINAL T <br />K X <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />I <br />NO, <br />FREQUENCY <br />SAMPLE <br /> EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS I MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 6. S WICE/ RA:; <br /> REQUIREMENT 1 l I N 1. i ' TI- I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT *4 q### '# # #i! tt2?t r n')=i'L?F: ' O a JIC?! F<r-+C' <br /> REQUIREMENT -*? 30DA AVG DAILY i10fd I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ?i f t-r# #:t : 3ciF't x## #i! } s o :; #?t# i?# 10 <br />IN <br />RC Ii <br /> REQUIREMENT + DA I L `i ! <br /> SAMPLE 03 <br /> MEASUREMENT <br /> PERMIT i'ORT F? 1F?1 ;F?4R i ? 3 Yh, .." ON IN C <br /> REQUIREMENT <br /> SAMPLE .. t :. x <br /> MEASUREMENT <br /> PERMIT R-PORT F: L' !z > #it yt ## ## #st### 1 714 T C>=! I 13I JAL. <br /> REQUIREMENT ;'37 i'fIAX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I ccmfy under penalty. at law thin this dtsument and all anachmenrs were "- ` TELEPHONE DATE <br /> i <br />d <br />d <br />d <br />d <br />i <br />h <br />i <br /> er my <br />on or supers islon in accordancc w <br />gned <br />prepare <br />un <br />irect <br />t <br />4 system <br />es <br />ichar1 u,'.- son <br />to,tc>ure that yuahfied pcnonnel property gather and esaluate the information <br /> <br />suhmitted Base) on my mywrc of the person ar persons whn manage the system <br />-' <br />-- <br /> <br />L cE : -e Sl!7 f`?: ; , <br />or those persons directly resp.msiblc for cnthenng the informaiioo <br />the information <br />. <br />• , <br />to the best of my km-, ledizw anal bchef <br />accurate <br />auhmitted is <br />wc <br />and complete (v 72 <br /> . <br />, <br />. <br />. <br />- <br />n,lt, ; i.,• , ibmmrn <br />, JNare that thereare si <br />ns icei <br />, <br />tali inio oration SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED . <br />f <br />sn <br />g <br />g <br />, <br />nsstbih:v al tine an.: ,e <br />r <br />, :encm far krnwin <br />cinlanans <br />en lulu°.c the OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> p <br />, <br />. <br />g <br />. CODE <br />V VIIImGll 10 Mllu G/ir ?illAl till Vr Mil T YIVL/iI IVIIJ tnVi Crrirl W all auaVrnncnw NCl c/ <br />?FC IP EVENT SUBJECT Tr BVRDFI'l OF PROOF 9FgJIF'F--M' r•;TS IN <br />i!IVISION W!-rHTN 4- <br />EPA Form 3320-1 (Rev. 3(99 Previous editions may be used. r XhiSlg;a form. PAGE OF