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PERMITTEE DDRESS (Include NATIONAL POLLUTAN HARGE ELIMINATION SYSTEM (NPDEJ) Approved <br /> factettl hams if dlgerent) V DISCHARGI IITORING REPORT (DMR) No. 2040-0004 <br /> NAME V�SyoOY_COY_AL_COV_VXXXVyXXXXVX-�vX-�VXXyXXXX_V __ (2-161 (17-19) Expires2-29-84 <br /> ADDRE86 ,,]4X[XXOXXXXXXXXXXXXX'XX /y�XX'TypyXX-/i•/-XXXXXX/i __ CD00602I 1 DD3 <br /> A A/1XT XX) X/UXkx—)R PERMIT NUMBER D16CNARGE NUMBER <br /> —_--_— XI;XXXX7EYX.X _—_----_—_—_—_--_---_ <br /> Yx.X�(,X 1300 S_Yale MONITORING PERIOD <br /> yy YEAR MO DAY YEAR MO DAY <br /> Y.X> Xl(Ia6lGX FlagstaffLAZ 86001 -------- FROM TO <br /> (20-21) (22- 3) (24-25) (26 ) (28-29) (30-31) NOTE: Read Instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) OUALITY OR CONCENTRATION <br /> PARAMETER (46-33) (54.61) (38.45) (46-33) (5"1) NO. FREQUENCY SAMPLE <br /> OF <br /> (32-37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS>< 62-63) (6468) (69-70) <br /> SAMPLE <br /> FLOW (CiF�It: �� MEASUREMENT XX NO DISCHARGE <br /> L _ * w w r r • + r w t t t <br /> PERMIT MGD 2 <br /> 5 S REQUIREMENT * * �, TF * �► r y- V. ?I' >f tk t w "�' 1k 'If Y' 'k /,Jit CT <br /> SAMPLE <br /> ci.,J%i q TL-T. - C,i)C: MEASUREMENT <br /> (EF'FLLIEh T) PERMIT LB/DA MG/L <br /> REQUIREMENT <br /> r SAMPLE <br /> IF0% jTL�1':_1L MEASUREMENT <br /> PERMIT' . I LB/DA MG/L <br /> REQUIREMENT 1k '>k It �i 'k R k # ��• •y a <br /> t <br /> _ SAMPLE <br /> Fti t IELD MEASUREMENT w w r <br /> PERMIT rr _ S L: ! J' !f�REQUIREMENT A T LI <br /> SAMPLE <br /> r I L C 1 G r MEASUREMENT w w w * * >r <br /> V I S U 4 L PERMIT MG/L <br /> ):>`ry AEQUIR£MHNT yr 9F it '� >rs • ^h ile Yc +1e ak k 74 M >k tt ,`• 1/3 0 tt <br /> SAMPLE <br /> Ci 0:TI1'TT`I MEASUREMENT <br /> T)-_'S (=FFLJ PERMIT 1 <br /> 7 .;,; f REQUIREMENT <br /> SAMPLE <br /> C7 MEASUREMENT <br /> U, PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOA / l <br /> H. Theodore Smith OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED RE RI.E SIG <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br /> Hydrologist NIFICAN7 PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 18 USC 11001 AND SIGNATURE OF PRINCIPAL EXECUTIVE 602 774-5253 87 ;L233 USC 11319 tPenalta� Ind- there Uamtn near Include /Inn up In IIa Ira.TYPED OR PRINTED and I.r lnasllnum urlprlepnment a/Mtlwrn 6..nth, nd.i yearn. OFFICER OR AUTHORIZED AGENT A NUMBER YEAR <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> IF NO :ISLHArL : ".:Ct ^� c. DURiN= THIS REPORTING PERIOD REPCIRT IIND DI-c-- HA: Z7t " <br /> ti ( <br /> .PA FOff17 3320-1 REV. 10-79)1'REVIOUS EDITION TO HE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br /> nvrn clrnnl v Ic —.HE <br />