Laserfiche WebLink
'F F : 1 , T� C z ( FERMIT N'•V SCR (DISCHARGE NUMBER' <br /> ----ter .r------ ------- L <br /> e—————————————— <br /> NITORING PER100 <br /> Un}--_(� ------ YEAR MO DAY SCAR 1 NO DAY <br /> LjQCATION �I�yJ.�r�a+i.1L+� J.,L `�V 1 OraUV ---.--- FROM TO N^ v <br /> (l 6 ) ( 8-a ) (Jo•JI) NOTE: Read Instructlons before completlnp this form. <br /> (J Card Only) QUANTITY OR LOADING (4 Curd Only) QUALITY OR CONCENTRATION <br /> PARAMCTCR (46-5J) fJ4-bJl (Jd-rl) (4643) (JL6J) NO. FREQUENCY SAM► <br /> (J1-37) EX A"w0ILrsls TYP <br /> >< AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITE 62-6J (64-6d) (69.71 <br /> SAMPLE <br /> FL: '- (EFF;.')c`k' T1 MEASUREMENT NO DIS HARGE <br /> FBRMIT 4 a v <br /> ` 1 R[OUIRBAf[NT * # a # +! '!' t * # SM # 'A' 't 'k •!F �► 77 �` # # {t . <br /> SAMPLE <br /> -O OLInE . T,�TAL 0•Jca MEASUREMENT <br /> SAMPLE <br /> InaN TOTyL MEASUREMENT <br /> I ,l t1 REOUIR�RBMT" ... _, . .. ., F •.,. ,c ,..�. i. <br /> Vr•` 'A' #' #' •Ir tfP' <br /> SAMPLE <br /> MEASUREMENT <br /> vo <br /> PERM IT' S ' <br /> n:)U V'�r R[QUIRBMBtiT. � � � � �- � _" ,v „ � - • r <br /> I <br /> SAMPLE <br /> ""'OIL p GREASE M[ASU RCM ENT <br /> I 3 U a L PBRMIT +' M <br /> RSOUIREM[!IT' i •a G/L <br /> b 0 0 1)2 ,.,rt It 5h �' yr` �1r ie t ar ►, 1 <br /> SAMPLE <br /> `J•:000TIV:T Y `.&/ P MEASUREMENT ,A, i. i `f •1r t i W <br /> (EFFLuE'.IT) FRRMIT- <br /> r <br /> SAMPLE <br /> MEASUREMENT <br /> ►BRUIT' - <br /> R[OUIREM[7M1T' <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNOER PENALTY OF LAW TMAT I NAVE ►-RSONALLY EXAMINED TELETHON[ D A T [ <br /> ANO AM FAMILIM .AT" TWC 1PWOMMATION SUBARTTED WEREIN ANO EASED <br /> ON MY INQUIRY OF TWOSE INDIVIOUALS IMMEOIATELY RESPONSIBLE FOR <br /> H. Theodore Smith OBTAINIMG r"C INFDI►MATION I BELIEVE TWE SUBARTTED 'NFORMAT)pM <br /> IS TRUE ACCURATE AND COMPL ETC I AM AWARE TWAT TW. RE ARE SIG. N, <br /> Hydrologist "IFIC'ANT PENALTIES Fop suaMrrnNc FALSE 'NFORM.TIO" 1"CLUDING 602 774-5253 86 10 <br /> Tt'.0 POSSIBILITY OF n"E ANO iMPR50NMENT SEE IB USC f 1001 ANO SIGNATURE OP PRINCIPAL EXECUTIVE <br /> 33 us 1,1319 1p nAllr. Iud" (Arr mrob. ^.Ar I^rlldr /Inr. w 1" $11101n <br /> TYPED OR PRINTED A.d'"r^.�iliwluw In1.^'°^""nl'./hrl"'rr^f"'^nIA.Awr'(vr�r.I OFFICER OR AUTHORIZED AGENT ARrNUMBER YEAR MO D <br /> Ic or <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (RFJFrrnc4 uU all"chme"Is here) <br /> IF )•C GI5C,4j1r-GE CCCU90c: I;URI 'G T^I° nE?C;�TI• G PE:: IG; 4EorjPT R^,G .^,I9CHagGc" <br /> EPA Form 3320-1 (Rev. 10.79)FR EVIOUS COITION TO BE USED (REPLACE! EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br /> UNTIL SUPPLY 16 CXHAUSTED , <br />